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TO  MY  FATHER 


HTDEOPHOBIA, 


HORATIO  R.  BIGELOW,  M.D., 


MEMBER  OF  THE  MEDICAL  ASSOCIATION  AND  LICENTIATE  OF  THE  MEDICAL  SOCIETY  OF 
THE  DISTRICT  OF  COLUMBIA. 


PHILADELPHIA : 

1).  G.  BRINTON,  115  SOUTH  SEVENTH  STREET. 

1881. 


Entered,  according  to  Act  of  Congress,  in  the  year  1881,  by 
D.  G.  BRINTON, 

In  the  Office  of  the  Librarian  of  Congress,  at  Washington,  D.  C. 


Press  ot  WM.  P.  FKLL  & CO., 

1220-1224  Sansom  Street. 


-vrvwTi; . 2,?,^  'i  "^7, 


Vo  I fc>  ’ 1'  S "h 

^4^  H 

REMOTE  STORAGE 

CONTENTS. ' 

CHAPTER  I. 


Nomenclature tl 

CHAPTER  II. 

History 14 

CHAPTER  III. 

Pathology  and  Morbid  Anatomy 36 

CHAPTER  lY. 

Incubation.  Influence  of  Age,  Sex  and  Climate 57 

CHAPTER  V. 

Symptoms.  Diagnosis.  Prognosis 79 

CHAPTER  VI. 


Treatment.  Preservative.  Suction.  Excision.  Cupping, 
Compression  and  Expression.  Cauterization.  Results  of 


Cauterization 95 

CHAPTER  VII. 

Treatment  continued.  Curative.  Curara.  Oxygen.  Turk- 
ish Baths.  General  Treatment 106 

CHAPTER  VIII. 

Treatment  continued.  Preventive 123 

CHAPTER  IX. 

How  to  recognize  a “ Mad”  Dog.  Emergencies,  and  how  to 
Treat  them 132 

CHAPTER  X. 

Curiosities  of  Literature 141 

CHAPTER  XL 

The  Most  Recent  Views  of  the  Pathology  and  Treatment  of 
Hydrophobia 148 


703078 


PREFACE. 


It  has  been  my  endeavor  to  embody  in  compact  form 
the  literature  pertaining  to  the  subject  of  hydrophobia. 
The  necessity  of  such  a work  has  been  long  recognized 
in  the  Profession,  and  the  growing  interest  among  the 
laity  leads  me  to  believe  that  they  will  receive  such  a 
publication  kindly.  The  bibliography  of  the  subject  is 
so  extensive,  covering  so  large-  a field  of  diverse  lan- 
guages, that  few  practitioners  have  the  facilities  of  trav- 
ersing it.  In  American  literature  there  never  has  been 
published  an  exhaustive  treatise  upon  the  disease,  scat- 
tering reports  in  medical  journals,  and  occasional 
monographs,  being  the  sum  of  all  that  has  been  written 
in  the  United  States.  To  condense  into  convenient  size 
the  History  of  the  disease,  to  state  succinctly  the  various 
theories  regarding  it,  and  to  give  the  latest  views  of  its 
Morbid  Anatomy  and  Treatment,  has  not  been  an  easy 
task.  The  library  of  the  Army  Museum  alone  contains 
over  three  thousand  monographs,  treatises,  and  articles 
bearing  upon  it.  Much  that  could  have  been  written 
is  unwritten,  that  the  work  might  be  kept  within  reason- 
able limits.  I have  preferred  to  keep  the  familiar  name, 
improper  though  it  may  be,  hydrophobia,  as  referring 
to  the  distinctive  disease  as  it  appears  in  man,  and  have 
not  discussed  Rabies,  or  the  disease  as  it  is  manifested  in 
the  other  orders  of  the  animal  kingdom.  Such  a discus- 
sion, as  rich  in  facts  and  inquiry  as  is  hydrophobia  itself 


Till 


PREFACE. 


would  require  a separate  volume,  and  is  the  proper  pro- 
vince of  the  Veterinarian.  As  will  appear  from  the 
credit  given,  I have  not  scrupled  to  draw  copiously 
from  such  excellent  sources  of  supply  as  Dr.  Dolan^s 
work,  Rabies  and  Hydrophobia  ; from  a publication  by 
Flemming,  with  a similar  title;  from  M.  Bouley’s  and 
Dr.  RusselFs  monographs;  and  from  such  German  litera- 
ture as  has  been  kindly  sent  me  by  the  United  States 
Consul  General  at  Berlin.  My  thanks  are  also  due  Dr. 
Fletcher,  of  the  Army  Medical  Library,  for  the  facilities 
of  investigation  extended  me.  An  excellent  account  of 
Hydrophobia,  together  with  a full  bibliography,  may  be 
found  in  the  Didionnaire  Rneyclopedique  des  Sciences 
MSdicaleSj  article  Rage,  The  History  of  the  Disease  is 
taken  from  Dolan,  Russell,  Flemming,  and  from  the 
reports  of  the  German  and  Austrian  Empires. 

Just  as  this  publication  was  going  to  press,  my  atten- 
tion was  called  to  some  articles  of  very  recent  date, 
which  are  interesting  as  expressing  the  latest  views  of 
j)athology  and  therapeutics.  It  is  gratifying  also  to  be 
supported  in  the  theory  that  I advanced  some  years  ago, 
that  hydrophobia  is  not  primarily  a neurosis,  but  a 
blood  disease — a theory  defended  for  many  years  by 
Virchow  and  other  eminent  German  pathologists.  It  is 
my  earnest  wish  that  this  little  book  may  not  be  without 
its  measure  of  profit  and  interest  to  physician  and  lay- 
man alike. 

1502  14^/i  Sthety  Washington^  D,  C. 


HTDEOPHOBIA. 


CHAPTER  I. 

NOMENCLATUEE. 

In  the  Boston  Medical  and  Surgical  Journal,^  Hr.  G. 
B.  Shattiick^  one  of  its  editors,  thus  writes,  concerning 
the  name  Hydrophobia,  as  descriptive  of  certain  symptoms 
conveyed  from  animal  to  animal.  ‘Ht  is  unfortunate  that 
age  should  enforce  our  respect  for  the  word  ^ hydrophobia,^ 
although  it  is  less  misleading  when  applied  to  the  disease 
as  if  appears  in  man  than  in  animals.  It  would  be  well, 
therefore,  when  treating  of  the  disease,  to  avoid,  Miydro- 
phobia,^  as  far  as  the  dog  is  concerned,  and  to  use  rather 
the  word  rabies.’^ 

Dr.  W.  A.  Hammond  expresses  himself  similarly 
^dlthough  there  are  objections  to  the  name  employed  to 
designate  the  terrible  disease  I now  propose  to  consider, 
the  same  is  true  of  all  other  terms  which  have  been  ap- 
plied to  it,  and  the  present  has  the  advantage  of  being 
well  known.  So  long  as  we  are  obliged,  through  ignor- 
ance of  pathology  and  morbid  anatomy,  to  use  a nomen- 
clature based  on  symptoms,  we  must  expect  to  be  inexact. 
The  name  hydrophobia  is  as  old  as  Galen,  and  still 
retains  its  preeminence,  notwithstanding  the  fact  that  the 
symptom  on  which  it  is  based  is  sometimes  absent.’^ 

* Boston  Medical  and  Surgical  Journal,  Feb.,  1878. 
t Diseases  of  the  Nervous  Systeyn^  New  York,  187(5. 

^ 9 


10 


HYDEOPHOBIA. 


In  the  Latin  monographs  of  tlie  middle  ages  the  name 
rabies  canina  was  the  one  in  common  use^  expressive 
neither  of  symptoms  nor  of  pathology,  but  referring 
solely  to  the  origin  of  the  disease.  Only  exceptionally  was 
it  the  case  that  any  distinction  was  made  between  rabies 
canina  and  hydrophobia.  In  the  French  literature  upon 
this  subject  rage  and  hydrophobie  are  used  synonymously. 
In  Germany  it  is  customary  to  speak  of  lyssa  des  hun- 
des,  and  the  word  lyssa  is  frequently  met  witli  among 
English  and  American  writers.  It  is  the  misfortune  of 
medical  science,  that  it  still  adheres  to  a nomenclature  of 
disease  which  found  origin  in  popular  superstition,  or  in 
mere  symptomatology,  without  regard  to  cause.  Recent 
enlightenment  has  done  much  to  revolutionize  the  sub- 
ject, and  the  time  may  not  be  in  the  far  future  when 
diseasas  will  be  classed  and  named  in  accordance  with 
special  pathological  changes. 

In  many  morbid  conditions,  but  more  especially  in  hy- 
drophobia, would  this  change  be  attended  with  difficulty, 
since  the  peculiarity  of  the  disease  depends  upon  ‘Ghe 
distribution  rather  than  upon  the  character  of  the  micro- 
scopical lesions.’’*  The  name  hydrophobia  is  an  improper 
one,  chiefly  because  the  symptom  to  which  the  origin  of 
the  word  refers  is  not  a constant  one.  They  who  build 
upon  the  shifting  sands  of  empiricism,  and  count  it  as  a 
divine  interposition  that  any  disease  should  not  conform 
to  the  evidences  of  popular  prejudice,  or  to  the  received 
symptomatology  of  ignorance,  might  negatively  be  the 
innocent  cause  of  suffering,  by  failing  to  recognize  a case 

* Dr.  Gowers,  Pathological  Transactions^  for  1877,  London  [vol. 
xxviii]. 


NOMENCLATURE. 


11 


of  hydrophobia  in  those  conditions  wherein  the  ^Mread 
of  water is  absent.  Fleming,*  than  whom  few  have 
written  more  clearly  upon  this  disease,  says : ^^AVe  have 
said  that  the  disease  is  popularly,  but  erroneously,  desig- 
nated hydrophobia.^^  This  term,  which  literally  means 
dread  of  water [ddojp,  water  and  (PolSoq,  fear),  is  only 
applicable  to  what  is  sometimes  a symptom  of  the  malady 
in  mankind,  the  aversion  to  water  or  other  liquids 
being  but  seldom,  if  ever,  observed  in  any  of  the  animals 
affected,  and  it  is  even  more  rare  in  man;  besides,  it  is 
not  a special  or  characteristic  symptom  when  present,  as 
a repugnance  to  fluids  is  occasionally  witnessed  in  various 
affections,  such  as  phrenitis,  hysteria,  gastritis  and  other 
disorders  of  the  human  species.  The  apparent  dread  of 
liquids  in  general  is  merely  the  result  of  an  instinctive 
dislike  induced  by  difficult  and  painful  attempts  to  swal- 
low, and  this  dislike  is  exaggerated  in  man — in  which 
the  symptom  is  most  marked — by  the  imagination,  when 
fluids  are  attempted  to  be  swallowed,  or  at  the  sight  or 
even  thought  of  these,  which  causes  spasms  of  the  pha- 
rynx, oesophagus,  and  adjacent  organs.  The  designation 
is,  therefore,  and  particularly  with  regard  to  the  lower 
animals,  inappropriate,  and  is  liable  to  mislead  and  prove 
most  dangerous  if  its  literal  meaning  be  alone  relied  upon 
to  distinguish  the  disease  from  other  maladies.  And  even 
the  dread,  when  present,  is  not  confined  to  water,  but  to 
all  fluids  indiscriminately;  a circumstance  which  has  led 
to  the  term  Hygrophobia  being  proposed,  instead  of  hy- 
drophobia. The  condition  of  intense  terror  and  the  fear 
of  everything,  animate  as  well  as  inanimate,  which  so 
* Rabies  and  Hydrophobia : George  Fleming,  London,  1872. 


12 


HYDROPHOBIA. 


painfully  marks  the  course  of  the  disease,  has  induced 
others  to  name  it  Pantephobia;  while  the  peculiar  nervous 
excitability  Avhich  is  developed,  even  by  a current  of  cold 
air  passing  over  the  patient,  caused  the  ancient  medical 
writers  to  particularize  it  as  Aerophobia,  From  a morbid 
supposition  sometimes  present  in  the  mind  of  the  suffer- 
ing individual,  that  he  was  personally  identified  with  the 
dog,  the  malady  was  at  one  time  named  Cyanfhropia,  and 
at  another  period  Cynolyssa,  from  the  fact  that  the  bite 
of  a venomous  animal  tormented  or  harassed.  By  others 
it  has  been  proposed  to  name  it  Dyseataposis,  a difficulty 
in  swallowing,  with  symptoms  of  choking;  also  Phobo- 
dipsloy  Erethisraus  hydrophobia,  Glonos  hydrophobia, 
and  lyssa  canina. 

The  ancient  Greeks  termed  it  lyssa  {Xu(T(7o)  or  lytta 
{aotto),  and  the  Romans  rabies,  Pliny  speaks  of  it  as  the 
rabidus  canis;  Cicero  says,  Hecubampatant  propter 
animi  acerbitatem  et  rabiem  in  canem  esse  conversara 
and  elsewhere  ^^Iracundie  et  rabie  se  facere  aliquid.’^ 
Horace  alludes  to  it  as  the  canis  rabiosa,  and  the  ^^dog 
days^^  as  the  rabiosa  tempora  signi;  and  Ovid  has  the 
expression  ‘^rabiem  collegit  dolor.^^  The  term  rabies’^ 
strictly  implies  fury,  madness,  fierceness,  etc.,  but  it  has 
also  been  employed  to  denote  poison.  Thus  Seneca  says. 
Sparge  intentam  rabiem  draconis  other  authors  at  this 
early  period  employed  the  term  rabies  to  designate 
this  particular  disease  of  dogs  and  other  creatures,  and  in 
recent  years  it  has  been  generally  adopted  by  veterinary 
writers.  It  is  certainly  a much  better  appellation  than 
that  of  hydropliobia,^^  inasmuch  as,  if  not  absolutely 
correct  in  its  definition  of  the  nature  or  character  of  the 


NOMENCLATURE. 


13 


affection,  it  does  not  mislead,  nor  is  it  likely  to  give  rise 
to  serious  blunders.  Besides,  it  must  correspond  with 
the  term  ^^mad’^  we  usually  apply  to  the  animal  suffer- 
ing from  the  malady,  and  which  fiiids  its  equivalent  in 
the  Frencli  rage;  the  German  hundswuth,  tollwuth^ 
wutlikrankheity  hundtoUheit ; the  arrabiato  or  rabbia  of 
the  Italians;  the  Spanish  rabioso,  or  mol  de  rabia;  and 
the  turbarea  of  the  Boumanians.  Linnaeus  divides  the 
disease  into  two  distinct  genera,  if  we  may  use  the  expres- 
sion, viz.,  rabies’^  and  hydrophobia.’^  The  first  he 
defined  in  these  words:  Desiderium  mordendi  laceran- 
dique  innocuos;  and  the  second,  Aversatio  potulentorum 
cum  rigor e et  saidiasi,  adding  scepius  prcecedmti  maritalaJ^ 
Dr.  Thomas  M.  Dolan  gives  the  following  synonyms: 
Lyssa,  Kuno-Lyssa,  Phobodyson,  Phangydron,  Babies 
canina.  Babies  contagiosa,  Entasia  Lyssa,  Canine  mad- 
ness, La  Bage  (French),  Die  Hundswuth,  Tollwuth  (Ger- 
man), Babbia  (Italian),  Hydrophobia  (Spanish),  Val- 
lenskrack  (Swedish),  Vandsky  (Danish),  Byechenstro 
(Bussian),  Byesnania  (Servian),  Wscieklizna  (Polish), 
Wcleklost  (Bohemian),  Sag  duranah  (Persian  and 
Turkish),  Kelevschote  (Hebrew),  etc. 


14 


HYDKOPHOBIA. 


CHAPTER  II. 

HISTOKY. 

Hydrophobia*  is  a disease  to  which  not  only  the 
human  species^  but  probably  all  of  the  brute  creation  are 
subject.  In  examining  history  we  find  that  the  Hebrew 
writers  are  altogether  silent  with  regard  to  it,  and  we  can 
discover  only  rare  allusions  to  it  among  other  authors 
j)revious  to  the  Christian  era.  Such  references,  however, 
are  sufficient  to  indicate  that,  although  it  may  not  have 
been  so  prevalent  among  the  nations  of  antiquity  as 
among  those  of  more  modern  periods,  yet  it  was  in  very 
ancient  times  recognized  as  a peculiar  disorder  infesting 
certain  animals,  and  even  man  himself. 

The  earliest  distinct  mention  of  the  disease  occurs  in  a 
Hindoo  medical  work  of  great  antiquity,  dating  probably 
as  far  back  as  nine  or  ten  centuries  before  Christ,  written 
by  a renowned  physician  named  Susruta.f  It  is  observed 
therein  that  when  dogs,  jackals,  foxes,  wolves,  bears  or 
tigers  become  rabid,  they  foam  at  the  mouth,  which  re- 
mains open,  and  from  which  flows  saliva;  their  tails  hang 
down ; they  do  not  hear  or  see  well ; they  snap  at  and 
bite  one  another,  and  thus  communicate  the  same  malady. 
The  symptoms  of  hydrophobia  in  human  beings  who 
have  been  bitten  are  likewise  detailed  briefly,  and  are  said 
to  terminate  in  convulsions  and  death.  Scarification  of 
the  wound  and  burning  it  with  boiling  ghee — a sort  of  oil 

Report  of  Charles  P.  Russel,  m.d.,  Sanitary  Insp.,  New  York, 
f Wise.  History  of  Medicine. 


HISTOEY. 


15 


made  from  butter — are  recommended^  as  well  as  various 
antidotes  to  be  subsequently  administered.  This  concise 
and  remarkably  accurate  description  of  the  affection,  with 
suggestions  for  treatment,  may  be  regarded  as  an  epitome 
of  all  ancient  and  modern  research  upon  the  subject. 

Homer  is  supposed,  by  some  authors,  though  without 
much  reason,  in  my  opinion,  to  allude  to  hydrophobia  in 
Iliad,  where  Hector  is  compared  to  a raging  dog.  Flem- 
ing, after  quoting  largely  from  the  Iliad,  thinks  it  more 
than  probable,  from  the  terms  employed,  xoya  Xoadr^rripa^ 

xpareprj  ds  i Xoaaa  de  du^ev  — o Xu<7(7a)dri(j  Xoaaa  de  ot  yjip^ 

etc.,  that  Homer  was  acquainted  with  the  malady.  In 
regard  to  the  early  history  he  writes,  Plutarch  asserts 
that,  according  to  Athenodorus,  it  was  first  observed  in 
mankind  in  the  days  of  the  Asclepiadse,  the  descendants 
of  the  God  of  Medicine,  ^sculapius,  by  his  sons  Poda- 
lirius  and  Machaon,  who  spread  through  Greece  and  Asia 
Minor,  as  an  order  of  priests,  prophets  and  physicians, 
preserving  the  results  of  the  medical  experience  acquired 
in  the  temples  as  a hereditary  secret.  They  were  the 
earliest  physicians  known  to  us,  and  it  is  not  unlikely 
that  they  may  have  been  the  first  to  observe  the  madness 
of  dogs  transmitted  to  mankind.  And  Pausanius,  in 
his  Travels  in  Greece  (Book  ix,  2),  alluding  to  the  story 
of  Actseon,  the  son  of  Aristseus  and  Autonoe,  who  was 
torn  to  pieces  by  his  own  fifty  dogs,  because  he  surprised 
Diana  and  her  attendants  at  the  bath,  was  of  opinion 
that  the  only  foundation  for  the  myth  arose  from  the 
circumstance  that  the  famous  hunter  was  destroyed  by 
the  dogs  when  they  were  rabid. 

There  are  two  passages  in  Hippocrates  which  appear 


16 


HYDROPHOBIA. 


to  indicate  that  the  physician  of  Cos  had  observed  its 
characteristic  symptoms  in  man,  but  failed  to  regard  it 
otherwise  than  as  a variety  of  idiopathic  phrenitis.  His 
cotemporary,  Democritus  (the  laughing  philosopher),  how- 
ever, who  was  a famous  traveler,  had  probably  encoun- 
tered the  disease  in  foreign  parts,  as  he  was  evidently  well 
acquainted  with  its  most  striking  peculiarities.  We  are 
imformed  by  the  distinguished  Roman  physician,  Coelius 
Aurelianus,  that  Democritus,  in  a treatise  upon  opistho- 
tonos, had  described  the  atfection  in  the  human  subject, 
admitting  its  origin  from  rabid  animals,  but  considering 
it  simply  as  a form  of  tetanus.  Theocritus  and  Plato  refer 
to  rabies  among  wolves.  Aristotle,  in  his  Hisfory  of 
Animals,  remarks  that  dogs  are  afflicted  with  madness, 
quinsy  and  gout;  that  the  first  renders  them  furious  and 
inclined  to  bite  other  animals,  who  thereupon  also  be- 
come rabid;  and  that  all  animals,  except  man,  are  liable 
to  be  seized  with  and  destroyed  by  the  malady  so  engen- 
dered. The  physicians  Artemidorous,  Gains  and  Ascle- 
piades,  also  mention  the  disease,  and  it  is  alluded  to  by 
Zenophon  and  Epicharmus. 

In  the  early  portions  of  the  Christian  era  references 
to  the  affection  by  physicians,  poets  and  other  writers, 
became  more  frequent.  M.  Artorius,  the  friend  and  med- 
ical attendant  of  Augustus,  speaks  oi  it,  in  a treatise  upon 
the  subject,  as  being  situated  in  the  stomach.  Gratius 
Faliscus,  a poet  of  the  same  period,  describes  rabies,  in  a 
work  entitled  the  Cynegeticon.  Virgil,  in  his  Georgies, 
classes  rabies  among  the  distempers  of  cattle  and  sheep, 
induced  by  a pestilential  condition  of  the  atmosphere. 
Ovid  speaks  of  a rabid  she  wolf,  and  rabid  centaurs,  and 


HISTOBY. 


17 


Pliny  of  the  bite  of  a mad  dog.  Horace  employs  the 
expression  rabies  canis^  in  a figurative  sense,  applying  it 
to  the  fierce  heat  of  the  dog  star.  The  disease  is  men- 
tioned by  Columella,  a writer  in  husbandry,  in  the  first 
century,  who  alludes  to  an  opinion  common  among  shep- 
herds, that  a dog  may  be  ensured  against  rabies  by  biting 
off  the  last  bone  of  its  tail  on  the  fortieth  day  after  birth. 

This  is  still  a popular  superstition  among  dog  fanciers 
in  some  countries.  Suetonius  refers  to  wild  animals 
affected  with  madness.  Eumedes,  a physician  in  the 
reign  of  Tiberius,  makes  some  interesting  observations 
upon  the  disease,  remarking  that  even  the  shedding  of 
tears  will  excite  spasms  in  an  affected  person. 

Dioscorides,  in  the  time  of  Nero,  appears  to  be  the  first 
who  claims  to  have  actually  treated  the  disease.  Both 
he  and  Galen  describe  it  as  attacking  animals  and  men, 
and  agree  in  the  opinion  of  its  communicability  from  the 
former  to  the  latter  by  contact  of  the  morbid  saliva  with 
the  second  skin.  But  Galen  and  Celsus  as  well  concern 
themselves  rather  with  the  prevention  and  treatment  of 
hydrophobia  than  with  its  history  and  progress.  Their 
cotemporary,  Magnus,  of  Ephesus,  locates  the  affection 
in  the  stomach  and  diaphragm.  According  to  Plutarch 
it  was  not  until  the  time  of  Pompey  the  Great  that  the 
rabific  poison  first  began  to  manifest  itself  among  human 
beings.  Andreas  of  Caryste,  a physician  of  th9  iUexan- 
drian  School,  has  left  a work  upon  the  ^isease  wBrch  he 
terms  xuyoXufTfroq.  Coelius  Aurelianus,  already  mentioned, 
a distinguished  physician  of  the  reign  of  Trajan  or  Adrian, 
or  perhaps  as  late  as  the  fifth  century,  is  the  first  to  fur- 
nish an  accurate  detailed  description  of  the  affection  in 


18 


HYDKOPHOBIA. 


man,  and  of  the  various  controversies  regarding  it.  He 
mentions  it  as  being  endemic  among  animals  in  Guria 
and  Crete. 

About  the  same  period  the  aftection  is  treated  by  a 
number  of  other  medical  men.  ^]tius,  a Mesopotamian 
doctor  of  the  sixth  century,  is  tne  first  to  furnish  any- 
thing like  an  accurate  description  of  rabies  in  dogs.^  A 
century  later  the  physician,  Pa  ulus  ^gineta,  gives  another 
excellent  account  of  hydrophobia.  Among  the  Arabian 
physicians,  Yahia  Ebn — Serapion,  Rhazes  Africanes  and 
Avicenna,  mentioned  the  disease,  the  latter  terming  it 
simply  ^‘canis  rabidi  morsus.’^  Since  the  time  of  Paulus 
^gineta  we  find  the  affection  described  by  numerous 
European  writers.  (Fleming  recounts thefollowingcurious 
history  of  a case  of  rabies  in  a bear,  recorded  about  the 
year  900^  At  that  time  immense  forests  covered  Bur- 
gundy, Maconnais,  Brescia  and  part  of  Lyonnais,  which 
were  infested  with  wolves,  wild  boars,  and  other  ferocious 
animals.  One  day  a bear,  following  the  course  of  the 
river  Saone,  at  last  arrived  at  the  quay  of  Lyons.  Every- 
body fled  except  some  boatmen,  who,  armed  with  heavy 
sticks,  attempted  to  kill  it.  The  bear,  little  intimidated 
by  their  number,  rushed  among  them  and  bit  about 
twenty.  Six  of  these  persons  were  shortly  afterwards 
smothered,  in  consequence  of  fearful  madness.  The  other 
fourteen,  however,  had  thrown  themselves  into  the  river, 
to  escape  the  animaFs  attack,  and,  it  is  affirmed,  were 
thus  preserved  from  the  effects  of  the  poison  by  its  being 
washed  out  of  their  wounds,  ^n  1026  an  outbreak  of 
rabies  among  dogs  in  Wales  is  mentioned,  in  the  laws  of 
Howel  the  Good,  j From  that  time  it  appears  to  have 


HISTOEY. 


19 


been  well  known  in  England,  numerous  specific  remedies, 
charms  and  incantations  against  it  being  recommended 
in  old  Anglo  Saxon  manuscripts  still  extant. 

Youatt*  gives  the  following  from  the  very  original 
works  of  Jacques  du  Fouilloux,  worthy  cynegetical 
writer  of  the  sixteenth  century.^^ 

AUTRE  RECEPTE  PAR  MOTS  PRESERYANTS  LA  RAGE. 

‘‘  Ay  appris  vne  recepte  dVn  gentil-homme  en  Bretagne,  le  quel 
fasoit  de  petits  escriteaux,  on  n’y  auvit  seulement  quedeaux  lignes, 
lesquels  il  mettoit  en  vne  omellette  d’oeufs,  puis  les  faisoit  analer 
aux  cliiens  que  au  Orient  este  mords  de  chiens  enragez,  et  auoit 
dedans  I’escriteau  YRan  Quiran  Cafran  Cafratrem^  Cofratrosque. 
Lesquels  mots  disoit  estre  singuliers  pour  empescher  les  cliiens  de 
la  Rage,  mais  quant  k moi  ie  n’y  adionste  pas  foy.”  And  he  goes 
on  to  say  that  while  he  cannot  credit  the  above,  yet  we  may  place 
implicit  confidence  in  his  own  prescription.  “ Baing  peur  lauer, 
les  chiens,  quand  ils  ont  este  mords  des  chiens  enragez,  de  peur 
qu’ils  enragent.  Qvand  les  chiens  sont  mords  ou  desbrayez  de 
chiens  enragez,  il  faut  incontinent  emplir  vne  pippe  d’eau  puis 
prendre  quatre  boisseaux  de  sel  et  les  letter  dedans,  en  meslant 
fort  le  sel  avec  vn  baston  pour  le  faire  fondre  soudainement.  Et 
quand  il  sera  fondu  faut  mettre  le  chiens  dedans,  et  le  plonger 
tout,  sans  qu’il  paroise  rien,  par  neuffois  ; puis  quand  il  sua  bien 
laue,  faut  le  laisser  aller  cel^  I’emperchira  d’enrager.’’ 

Fleming  quotes  from  a manuscript  of  the  fourteenth 
century,  published  by  Hofman  [Fundgruben,  Book  1,  p, 
324). 

“ Wilt  er  einen  wirtenden  hunt  erkennen,  so  merke  wenn  er  loufet 
mit  ofenen  munde,  unde  mit  uzgehangener  Zungen,  Swenne  er 
sich  anseifert  unde  den  Zagel  under  bei  bein  smuget  unde  sins 
selbes  schin  an  billet,  Swenne  er  anderhunde  rluhet,  willter  wizzen 
wen  ein  wutender  hund  gebizzen  hat,  so  nim  des  blutes,  daz  ur 
der  wunden  get,  unde  strich  daz  an  ein  brot  unde  wirf  ezernein 
hunde  ; rluhet  ez  der  hunt ; so  ist  jener  hunt  wutende  gewesen,  der 

* Youatt  on  the  Dog^  Philadelphia,  1847. 


20 


HYDKOPHOBIA. 


die  gebizzen  hat.  Swen  ein  wutendee  brizet  dem  troumet  grew- 
lichen,  unde  zumet  ane  schulde,  unde  sihet  allez  hinter  sich  unde 
mac  nicht  erliden  daz  man  in  ain  sihet,  under  wrechtet  daz  wazzer 
unde  swenne  er  ez  an  sihet,  so  billet  er  als  ein  hunt.  Wilter  ein  zu 
helfe  kumen,  so  tu  im  di  wunden  uf  mit  ysen  oder  mit  fuer,  daz  daz 
eiter  uz  rliez  mit  dem  blute.  Setze  im  egeln  un  di  wunden  di  daz 
eiter  uz  Zehen.  ********  Ein  gebrante  hundes 
leber  gipim  Zizzen.  ******  Gegendes  menschen  biz 
vrumet  kelber  bein,  so  si  gebrant  werden  unde  gepulrert  und  mit 
horrige  getempert  so  sal  man  si  legen  uf  den  biz.” 

One  of  the  earliest  reports  of  scientific  interest  refers 
to  wolves  afflicted  with  hydrophobia  in  Franconia,  Ger- 
many, in  1271.  More  than  thirty  shepherds  and 
peasants  fell  victims  to  their  attacks.  In  1500  Spain 
suffered  from  the  ravages  of  canine  madness.  In  1532, 
a rabid  dog  is  said  to  have  strangled  the  Cardinal 
Creseiice,  the  Legatee  of  the  Pope,  at  the  Council  of 
Trent.  According  to  Foster  there  was  an  epizooty  of 
rabies  among  dogs  at  the  same  time  with  the  epidemic 
plague  in  Flanders,  Turkey,  Hungary  and  Austria,  in 
1586.  Bauhin  informs  us  that  in  1590  it  appeared  in 
an  epizootic  form  among  the  wolves  of  Monthelliard, 
and  in  1604  it  was  widespread  in  Paris.  In  1691 
dogs  in  great  numbers  became  mad  throughout  Italy, 
and  in  1708  it  was  epizootic  among  dogs  in  Suabia. 
Fleming  states  that  in  1712  wild  beasts  of  all  kinds 
perished  in  large  numbers  at  Somogy,  Hungary,  and 
in  the  woods  the  country  people  found  dogs  which  had 
been  driven  there  by  madness.  Men  bitten  by  them 
were  quickly  seized  with  frenzy  and  hydrophobia.  From 
1719  to  1721  severe  outbreaks  of  the  disease  took  place 
in  France  and  Germany,  and  in  1722  and  ^23  it  pre- 


HISTORY. 


21 


vailed  in  Silesia,  invading  Hungary,  and  it  visited 
other  portions  of  Europe  in  1725  and  1726.  Hogs, 
wolves,  and  wild  animals  generally,  were  affected,  par- 
ticularly in  Silesia  and  Lusatia. 

The  disease,  according  to  Huxham,  prevailed  in  Eng- 
land in  1734-5.  Hughes,  in  his  History  of  Barbadoes, 
narrates  that  in  1741  many  dogs  went  mad  in  those 
islands.  The  county  of  Fife,  Scotland,  was  infested 
with  mad  dogs  in  1748.  In  1752  numerous  mad  dogs 
Avere  reported  about  St.  James,  London,  and  orders  were 
issued  to  shoot  all  that  appeared.  According  to  Layard, 
London  again  suffered  from  the  disease  between  1759 
and  1762.  In  1763  it  broke  out  among  dogs  in  Italy, 
France  and  Spain,  and  in  many  places  all  dogs  Avere 
slaughtered.  In  Madrid  900  Avere  killed  in  a single 
day.  ^Rabies  Avas  alarmingly  frequent  among  dogs  and 
foxes  in  Boston  and  its  neighborhood  in  1768,  ^70  and 
^71,  when  it  Avas  then  regarded  as  a novel  diseas^ 
Lipscomb  says  that  the  disease  was  very  general  in 
England  in  1774.  From  1776  to  ^78  it  reigned  almost 
continually  in  the  French  West  Indies,  the  true  disease 
never  having  been  observed  there  before.  Ijn  1779  it 
Avas  very  common  among  dogs  in  the  city  of  Philadel- 
phia and  in  Maryland,  and  in  the  same  year  it  affected 
Avolves  in  Belluno,  Italy,  and  about  Bourges,  Franc^ 
In  1783  it  made  its  advent  in  the  island  of  Jamaica  and 
Hispaniola,  as  a very  serious  epizootic.  Un  1785-6-9, 
canine  madness  Avas  extremely  prevalent  throughout  the 
United  States!|  In  1788  it  raged  in  England.  From 
1785  to  ^89  various  portions  of  Europe  Avere  afflicted, 
the  country  people  being  terrified  by  numerous  rabid 


22 


HYDROPHOBIA. 


wolves.  In  the  latter  year  the  disease  was  particularly 
prevalent  in  Munster,  Westphalia,  (in  1797  it  was 
epizo5tic  in  Rhode  Island,  U. 

About  the  commencement  of  the  present  century  it 
was  noticed  that  foxes  began  to  suffer  frequently  from 
rabies.  In  1803  these  animals  were  running  mad  in 
large  numbers  through  the  Pays  de  Vaud,  and  in  the 
Aubonne,  Orbe,  Cossenay,  and  Yserden  districts,  at  the 
foot  of  the  Jura.  In  1804  similar  outbreaks  of  vulpine 
madness  occurred  on  the  northern  shore  of  the  Lake  of 
Constance,  and  thence  extended  through  Germany. 
This  epizooty  continued  more  or  less  until  1837,  attack- 
ing the  foxes  of  Wurtemberg,  Baden,  Bavaria,  the  up- 
per Danube,  the  Black  Forest,  Forest  of  Thuringia, 
Jena,  the  Voralberg,  Upper  and  Lower  Hesse,  Hanover, 
Hohenzollern,  Rottenberg,  and  Ulm.  At  this  period 
badgers  were  also  observed  to  be  affected.  We  are 
informed  by  Blaine  that  in  1806  rabies  in  the  dog  so 
abounded  in  the  neighborhood  of  London  that  scarcely 
a day  passed  without  his  being  consulted  about  one  or 
more  cases,  and  sometimes  he  attended  three,  four,  or 
five  a day,  for  weeks  together.  From  that  period  until 
1823  it  prevailed  every  year  in  London  and  its  suburbs. 
The  most  memorable  period  in  the  records  of  hydropho- 
bia was  between  the  years  1803  and  18S0,  when  it 
appeared  to  an  unheard  of  degree  in  many  portions  of 
both  Europe  and  America. 

In  the  summers  of  1803  and  1804,  during  the  pres- 
ence of  excessive  heat,  and  after  long  continued  warm 
weather,  it  broke  out  upon  the  northern  coast  of  Peru. 
It  is  described  as  it  prevailed  in  that  country  by  Prof. 


HISTORY. 


23 


Unaiuie,  Proto-Medico.  His  account^  though  somewhat 
liigbly  colored,  is,  nevertheless,  extremely  interesting. 
He  informs  us  that  the  disease  became  general  among 
quadrupeds,  attacking  them  indiscriminately;  but  fix- 
ing itself  especially  upon  dogs.  The  dogs  exhibited  the 
ordinary  appearances  of  the  affection.  The  cats  ran 
about  with  hair  erect.  The  horses  and  asses  were  arrayed 
against  each  other.  The  cattle  leaped  furiously,  and 
engaged  in  hostile  encounters.  The  disease,  engendered, 
as  the  professor  believed,  by  atmospheric  conditions,  was 
subsequently  propagated  by  specific  contagion,  spreading 
into  the  interior  of  the  country.  It  proved  fatal  to 
many  of  the  inhabitants  of  Arequipa  and  Tea,  carrying 
off  forty-two  persons  in  the  latter  town  alone.  In  one 
instance,  twelve  fell  victims  out  of  fourteen  bitten  by  a 
single  dog.  The  largest  number  of  deaths  occurred  in 
from  twelve  to  ninety  days  after  the  bite.  The  affection 
would,  therefore,  appear  to  have  been  of  a more  virulent 
character  than  usual.  It  is  likewise  related  that  a num- 
ber of  slaves  upon  a sugar  plantation  contracted  the 
disease  by  feeding  upon  the  beef  of  rabid  cattle,  a state- 
ment which  we  can  hardly  accept  as  true.  Gohier  alone 
mentions  similar  instances.  He  states  that  he  has  seen 
hydrophobia  in  dogs  result  from  eating  the  flesh  of  a 
rabid  dog  in  one  instance,  and  of  a rabid  sheej)  in  anoth- 
er. But  a large  number  of  experiments  by  Hertwig 
would  seem  to  prove  the  innocuousness  of  such  food. 

About  the  same  period  hydrophobia  was  noticed  to  be 
remarkably  prevalent  in  many  portions  of  the  United 
States,  where  the  medical  literature  of  the  time  abounded 
with  accounts  of  cases  and  discussions  as  to  the  character 


24 


HYDROPHOBIA. 


and  treatment  of  the  disease.  In  1810  Southern  Russia 
was  scourged  by  the  affection.  In  Prussia,  between 
1810  and  1819,  its  human  victims  amounted  to  1635,  a 
large  number  of  whom  owed  their  deaths  to  the  attacks 
of  rabid  wolves.  In  1815  it  prevailed  in  Austria,  and  at 
the  same  time,  according  to  Viborg,  it  raged  in  Copen- 
hagen. In  Podolia,  in  1818,  Marochetti,  a celebrated 
Russian  physician,  attended  no  fewer  than  twenty-six 
cases  of  hydrophobia  in  the  human  subject,  and  shortly 
afterward  announced  to  the  medical  world  his  so-called 
discovery  of  Lyssi,  which  created  a great  sensation. 
According  to  his  description  the  hydrophobic  virus,  after 
the  bite  of  a rabid  animal,  is  transported  to  and  deposited 
in  the  orifices  of  the  secretory  ducts  of  the  sublingual 
glands,  beside  the  freniim  linguae  and  upon  the  lateral 
parts  of  the  inferior  surface  of  the  tongue,  where  form 
a number  of  vesicles  or  pustules  of  variable  size,  in  which, 
by  means  of  a probe,  fluctuation  can  be  detected.  . It 
cannot  be  determined  precisely  Avhen  these  pustules 
appear — ordinarily  between  the  third  and  ninth  days 
after  the  bite  — sometimes  the  twentieth  day,  or  even 
later.  If  the  poison  in  these  pustules  be  not  destroyed 
by  cauterization  during  the  first  twenty-four  hours  of 
their  appearance,  it  will  be  removed  from  them  by  resorp- 
tion, producing  metastasis  to  the  brain  and  nervous  sys- 
tem, with  resulting  hydrophobia.  Thus,  according  to 
Marochetti,  the  virus  does  not  remain  in  the  wound 
where  it  was  originally  deposited,  but  is  quickly  conveyed 
in  all  its  integrity  to  the  sublingual  glands.  According 
to  this  physician,  similar  appearances  are  to  be  found  in 
rabid  dogs  and  other  animals. 


HISTORY. 


25 


In  1822,  Magistel,  a French  doctor,  was  said  to  have 
confirmed  the  existence  of  these  pustules  in  several 
cases  coming  under  his  observation ; but,  notwithstand- 
ing the  treatment  recommended  and  applied,  five  out  of 
ten  persons  bitten  by  one  dog  were  seized  with  the  mal- 
ady and  died.  The  truth  is,  as  Watson  observes,  that 
the  mucous  follicles  of  the  mouth,  and  those  at  the  base 
of  and  particularly  beneath  the  tongue,  are  commonly 
exaggerated  in  both  men  and  dogs  laboring  under  the 
disease;  and  these  enlarged  follicles  were  regarded  by 
Marochetti  and  Magistel  as  a specific  eruption  furnishing 
the  virus  and  pabulum  of  this  complaint.  In  1819 
rabies  prevailed  in  Canada,  whose  Governor-General,  the 
Duke  of  Richmond,  fell  a victim  to  it,  having  been  bit- 
ten by  a captive  fox.  In  1820,  as  Blaine  informs  us, 
rabies  canina  was  again  rife  in  England,  and  continued 
alarmingly  prevalent  for  a number  of  years.  In  1822 
it  was  common  in  Holland.  In  1819  and  1829  Italy 
suffered  from  the  disease;  and  Brera  mentions  the 
circumstance  of  a wolf ^s  having  communicated  it  to  nine 
persons  out  of  thirteen  whom  it  had  bitten.  The  period 
between  1819  and  ^27  is  particularly  noticed  by  AYirth 
as  remarkable  for  the  prevalence  of  rabies  among  the 
foxes  of  Switzerland  and  Germany,  and  those  animals 
infected  large  numbers  of  dogs,  cats,  horned  cattle, 
horses,  pigs,  goats,  and  sheep.  Notwithstanding  their 
natural  shyness,  the  mad  foxes  boldly  faced  and  followed 
men  and  animals  in  order  to  attack  them.  In  1824, 
throughout  many  districts  of  Russia,  and  extending 
thence  into  Sweden  and  Norway,  the  disease  prevailed 
extensively  among  foxes,  wolves,  dogs,  cats,  and  reindeer. 


26 


HYDROPHOBIA. 


In  1828  its  human  victims  in  England  and  Wales 
X amounted  to  twenty-eight.  In  1829,  according  to  the 
Veterinary^  Professor  Prinz,  it  was  destructive  in  Dres- 
den. From  1823  to  1829^  as  Hertwig  informs  us,  it 
Avas  unusually  common  in  Berlin,  and  as  Bohme  states, 
in  Saxony,  also. 

In  1830  the  subject  of  hydrophobia  had  so  alarmed 
the  public  mind  that  the  House  of  Commons  thought 
lit  to  appoint  a select  committee  to  investigate  it.  Evi- 
dence was  furnished  by  many  eminent  physicians,  sur- 
geons, and  veterinarians,  among  whom  may  be  men- 
tioned Sir  Benjamin  Brodie,  Mr.  Benj.  Travers,  Mr. 
Morgan,  of  Guy^s  Hospital,  Mr.  Earle,  of  St.  Bartholo- 
mew's, Prof.  Coleman,  and  Mr.  Wm.  Youatt.  Mr. 
Earle  presented  positive  proof  of  the  undue  prevalence 
and  increase  of  the  disease  in  England  during  his  time, 
remarking  that  he  had  witnessed  twenty-five  cases  in  the 
human  subject  within  as  many  years,  whereas  his  father 
had  seen  but  one  in  fifty  years  of  previous  practice. 
Mr.  Youatt  testified  that  he  had  recently  applied  lunar 
caustic  successfully  to  some  four  hundred  bitten  persons, 
and  a surgeon  of  St.  George’s  affirmed  that  he  had  simi- 
larly treated  four  thousand  without  an  accident.  Dur- 
ing the  second  quarter  of  the  present  century,  as  com- 
pared with  the  first,  there  ensued  a decided  abatement 
of  the  disease  in  England,  owing  to  the  creation  of  the 
dog  tax,  and  the  enactment  of  other  laws  calculated  to 
decrease  the  number  of  worthless  curs.  In  Vienna,  in 
1830,  there  were  reported,  in  rapid  succession,  thirty- 
nine  cases  of  rabies  in  the  dog.  It  then  almost  disap- 
peared until  1838,  when  one  hundred  and  seventeen 


HISTORY. 


27 


cases  occurred.  In  1839  there  were  reported  63  cases; 
317  in  1840,  and  141  in  1841.  Of  the  last,  only  fifteen 
were  bitches.  The  largest  number  of  cases  wc^re  noticed 
in  February  and  May,  twenty-one  respectively,  and  the 
fewest  in  September,  November  and  December.  Be- 
tween 1830  and  1847  there  were  1038  human  victims 
to  hydrophobia  in  Austria.  In  1831  and  ^32  canine 
rabies  was  widespread  in  the  Duchy  of  Prosen.  In 
1833  it  existed  to  an  alarming  extent  in  Barbadoes.  In 
1834-35  it  prevailed  in  Saxony,  Pomerania  and  Switz- 
erland. In  1835  it  was  frequent  in  Chili,  South  Amer- 
ica. In  1836  it  was  seriously  prevalent  in  Paris,  and 
in  1839  to  ^42,  according  to  Prof.  Remy,  the  disease  was 
epizootic  among  the  foxes  of  Wurtemberg,  and  was  by 
them  communicated  to  many  dogs,  and  a large  number 
of  the  latter  animals  were  thus  affected  in  Baden.  Be- 
tween 1840  and  1842  the  malady  appeared  in  the  vari- 
ous departments  of  France,  being  particularly  destructive 
in  Lyons  and  its  vicinity. 

In  May,  1844,  great  numbers  of  mad  dogs  were  seen 
in  Roscommon,  Ireland.  In  the  same  year  it  made  its 
first  appearance  in  Malta,  and  became  very  serious.  In 
1851  and  1852  there  was  a terrible  epizootic  of  canine 
rabies  in  Northern  Germany.  In  1852,  in  the  small 
town  of  Adalia,  Turkish  Provinces,  a mad  wolf  bit  128 
persons  and  a great  number  of  cattle.  In  1858  hydro- 
phobia became  so  destructive  in  Algeria,  that  the  Gover- 
nor-General was  compelled  to  issue  a circular  relative  to 
jireventive  measures.  From  1855  to  1860  the  disease 
was  common  in  England,  in  Northern  Germany,  in 
France  and  in  Spain.  In  1860  it  prevailed  very  exten- 


28 


HYDEOPHOBIA. 


sively  among  dogs,  and  was  very  destructive  to  cattle  in 
Ohio  and  Missouri.  Between  I860  and  1862  numerous 
cases  of  hydrophobia  communicated  from  dogs  to  natives, 
occurred  in  China,  at  Tietsien,  near  Pekin,  and  at  Can- 
ton, Avhile  about  the  same  period  the  presence  of  rabies 
was  more  than  usually  noted  in  Vienna  and  Rhenish 
Prussia,  According  to  Sir  Samuel  Baker,  the  disease 
was  epizootic  in  Abyssinia  in  1862.  In  Bavaria,  between 
1873  and  1867,  there  was  a yearly  average  of  800  cases 
of  hydrophobia  in  a total  of  275,000  dogs.  From  1863 
to  1867  it  was  very  prevalent  in  Saxony  also,  where,  in 
the  last  three  years  of  that  period,  there  were  reported 
764  cases  of  canine  madness.  It  created  much  alarm  in 
Lancashire,  England,  in  1864.  In  1864-5  the  city  of 
Lyons  was  thrown  into  great  excitement  on  account  of 
the  terrible  frequency  of  this  redoubtable  disease.  In 
1865  it  was  unusually  common  in  the  vicinity  of  Lon- 
don, and  during  the  next  year  it  assumed  formidable 
dimensions  in  England.  In  1866  it  was  epizootic  in 
Athens,  Greece.  In  1867  the  English  dogs  at  Siianghai, 
China,  were  seriously  affected,  and  a number  of  persons 
were  bitten,  with  fatal  results.  In  1868  many  mad  dogs 
were  seen  in  Belgium,  a country  usually  exempt  from 
the  affection.  In  1869  the  disease  was  rife  in  Paris. 
In  1870  canine  rabies  created  great  terror  in  the  north 
of  England,  and  it  has  prevailed  very  constantly  in  that 
country  up  to  the  present  time.  Fleming  remarks  that 
the  wide  and  serious  extension  of  this  epizooty  over  the 
country  appears  to  have  been  largely  due  to  the  insuffi- 
ciency of  the  police  measures  adopted  in  the  different 
towns  and  districts,  the  late  period  at  which  they  Avere 


HISTOKY. 


29 


introduced,  the  want  of  a proper  and  uniform  sanitary 
organization  to  combat  the  spread  of  this  and  other  con- 
tagious diseases  of  animals,  and  the  general  ignorance 
prevailing  with  regard  to  its  symptoms  and  nature/^ 
In  1871  hydrophobia  was  remarkably  fatal  in  Barba- 
does.  Q^rtel  reports  a severe  epizootic  of  the  disease 
among  foxes  in  Carinthia,  1866  to  1872. 

In  France,  between  1854  and  1860,  the  number  of 
deaths  were  computed  by  the  Minister  of  Public  Works 
at  1000.  In  Prussia,  from  1810  to  1819,  there  were 
1635  deaths,  and  1073  from  1820  to  1834.  In  Bavaria, 
between  1839  and  1847,  the  mortality  was  39.  The 
Austrian  Empire  suffered  severely  during  the  period 
from  1830  to  1847,  when  1038  persons  succumbed  to 
hydrophobia.  In  Sweden  the  mean  annual  death  rate 
at  four  different  periods  of  the  disease  was : 58  from 
1778  to  1785,  138  from  1786  to  1790,  6 from  1831  to 
1835,  and  42  from  1856  to  1860.  In  Belgium,  between 
1856  and  1860,  there  were  26  deaths.  In  Algeria,  from 
1844  to  1863,  there  were  recorded  47  deaths  — 34  Eu- 
ropeans, 7 natives,  6 nationality  unknown.  The  deaths 
in  England  in  1838  amounted  to  24;  in  1839  to  15;  in 
1840  to  12;  in  1841  to  70;  in  1842  to  15;  in  1847  to 
5;  in  1848  to7;  in  1849  tol7;  in  1850  to  13;  in  1851 
to  25;  in  1852  to  15;  in  1853  to  11;  in  1854  to  16;  in 
1855  to  14;  in  1856  to  5;  in  1857  to  3;  in  1858  to  2; 
in  1859  to  4;  in  1860  to  3;  in  1861  to  4;  in  1862  to  1; 
in  1863  to  4;  in  1864  to  12;  in  1865  to  19;  in  1866  to 
36;  in  1867  to  10;  in  1868  to  7;  in  1869  to  18;  in 
1870  to  32;  in  1871  to  56;  in  1872  to  39;  and  in  1873 
to  28.  In  Scotland,  between  1855  and  1863,  only  12 


30 


HYDROPHOBIA. 


persons  died  from  hydrophobia,  and  none  in  the  suc- 
ceeding three  years.  According  to  the  National  Census, 
there  occurred  in  the  United  States  during  the  year  end- 
ing June  1,  1860,  a mortality  from  hydrophobia  of  38. 
In  New  York  city  the  following  has  been  the  death 
rate:  In  1855  there  occurred  4 deaths;  in  1856,  3 deaths; 
in  1857,  2 deaths;  in  1858,  no  deaths;  in  1859,  2 deaths; 
in  1860,  no  deaths;  in  1861,  5 deaths;  in  1862,  1 death; 
in  1863,  3 deaths;  in  1864,  1 death,  in  1865,  3 deaths; 
in  1866,  2 deaths;  in  1867,  4 deaths;  in  1868,  1 death; 
in  1869,  5 deaths;  in  1870,  3 deaths;  in  1871,  7 deaths; 
in  1872,  6 deaths;  in  1873,  no  deaths;  in  1874,  5 deaths. 
According  to  the  United  States  Census  for  the  year  end- 
ing June  1,  1870,  there  had  occurred  in  the  State  of 
Louisiana  alone,  22  deaths  from  hydrophobia,  in  a total 
for  the  whole  country  of  63;  of  the  remainder  the  States 
of  New  York  and  Pennsylvania  each  furnished  9.^^ 

In  the  New  York  Herald^  of  April  23d,  1879,  there 
is  recounted  an  interesting  case  of  hydrophobia,  which 
is  quoted  under  the  chapter  on  ‘^Syrnptoms.^^  In  the 
same  journal,  under  date  of  April  30th,  1879,  we  find 
the  following  editorial : — 

^‘Several  deaths  have  recently  occurred  which  the  attending 
physicians  describe  as  deaths  from  hydrophobia.  In  every  case 
there  was  a well-established  history  of  the  patients  being  bitten  by 
a dog,  and  they  died  with  the  symptoms  usually  described  as  due 
to  this  disease.  /For  doctors,  and,  unfortunately,  for  the  public, 
this  sequence  of  facts  from  the  bite  to  the  horrible  death  is  all  very 
real  and  very  regular,  and  is  a constant  element  of  the  daily  news, 
despite  all  the  arguments  of  the  extravagant  philosophers  who 
maintain  that  there  is  no  such  disease,  and  that  the  imagination 
of  the  victims  is  responsible  for  all.  But  nobody  knows  the  precise 
mode  by  which  this  virus  operates  in  the  system,  and  nobody  con- 


HISTORY. 


31 


sequently  knows  how  to  head  it  off  medically;  and  the  empirical 
system  by  which  in  the  course  of  ages  every  conceivable  remedy 
has  been  tried  has  not  brought  to  light  one  single  agent  that  the 
physician  can  confidently  regard  as  a sure  resource  against  this 
terrible  malady./  Many  cases  have  been  reported  as  cured,  but 
nobody  knows  whether  they  were  cured.  The  persons  may  not 
have  had  the  disease.  Every  person  bitten  does  not  take  it ; not 
even  every  person  bitten  by  dogs  certainly  mad.  In  many  persons 
there  is  a singular  resistance  to  the  poison,  just  as  there  may  be 
and  is  an  equal  resistance  to  any  poison  whatever.  Every  person 
exposed  even  to  the  plague  does  not  take  it.  We  give  elsewhere* 
a communication  signed  “ J.  M.,”  which  reports  cures  in  Russia 
from  the  inhalation  of  oxygen.  These  appear  to  be  clear  and 
authentic  histories,  and  they  afford  good  reason  for  basing  treat- 
ment on  this  plan.  Any  plan  that  affords  a clear  hope  is  not  to  be 
rejected.  This  treatment  would  seem  to  imply  that  the  essential 
fact  in  the  morbid  process  is  a deoxygenation  of  the  blood ; and 
the  blood  corpuscles  are  so  affected  by  the  poison  that  they  cannot 
obtain  oxygen  as  presented  in  its  ordinary  condition.  All  the 
symptoms  are  such  as  would  answer  to  this  origin,  and  the  treat- 
ment in  its  ultimate  operation  analogous  to  the  successful  treatment 
of  rattlesnake  bites  with  ammonia.” 

As  an  evidence  of  the  anxiety  of  the  laity  in  regard 
to  hydrophobia,  the  following  has  been  clipped  from  the 
Herald,  of  same  date : — 

AN  ANXIOUS  QUESTION. 

New  Hampton,  N.  J.,  April  28,  1879. 

To  the  Editor  of  the  Herald : — 

I had  the  misfortune  to  have  my  little  three -year- old  girl  bitten 
by  a Spitz  dog  on  the  face.  The  dog  was  not  mad,  but  surly  and 
ill-tempered.  I had  the  wound  cauterized  in  a few  minutes  after 
the  child  was  bitten.  Does  a person  bitten  by  a Spitz  dog  invari- 
ably become  attacked  with  hydrophobia?  Some  time  ago  you  pub- 
lished articles  on  the  dangers  of  Spitz  dogs,  and  I appeal  to  you  or 
your  readers  to  give  me  information  on  the  subject. 

An  Anxious  Father. 

* Quoted  under  chapter  on  Treatment.” 


32 


HYDROPHOBIA. 


In  the  summer  of  1877,  a celebrated  actress  was  bitten 
by  a Spitz  dog  in  New  York  city,  and  died  shortly  after, 
of  hydrophobia.  The  Washington  Evening  Star  of  Feb., 
1879,  reports  from  the  Philadelphia  Times  an  interesting 
case  in  which  the  little  son  being  bitten  by  a rabid  dog, 
recovered.  The  mother,  who  was  also  bitten  in  the 
attempt  to  rescue  the  boy,  died  shortly  afterward,  of  hy- 
drophobia; while  a man,  who  was  bitten  by  the  same 
dog,  on  the  same  day,  suffered  no  ill  effects.  The  Star 
also  reports  a case  occurring  in  Fall  River,  Massachu- 
setts, in  which  one  Joseph  Passono  was  bitten  by  two 
hounds  in  the  hand  and  leg.  The  wounds  were  cauter- 
ized, but  the  victim  died  of  hydrophobia.  During  ten 
years,  from  1867  to  1876,  inclusive,  there  were  but  six 
recorded  deaths  from  hydrophobia  in  Massachusetts,  and 
of  these,  two  occurred  in  1870,  and  the  other  four  in 
1876.*  In  France,  with  a population  of  36,000,000, 
during  the  six  years  from  1853  to  1858  inclusive,  there 
were  107  cases  of  hydrophobia;  or  one  case,  annually, 
for  every  2,000,000  inhabitants.  In  the  department  of 
the  Seine,  with  an  average  population  of  upward  of 
1,000,000,  din  ing  the  forty  years  from  1822  to  1862, 
there  were  94  cases,  or  a little  more  than  2J  per  annum. 
In  1878,  Madame  Bakm6teff,  the  wife  of  a Russian 
member  of  Legation,  and  the  daughter  of  a Washington 
lady,  returning  from  a drive  in  Paris,  where  she  was 
living,  was  met  by  a favorite  poodle,  who  flew  at  her 
savagely,  tearing  her  clothes,  biting  her,  and  exhibiting 
all  the  symptoms  of  rabies.  The  wound  was  cauterized 
and  the  lady  has  never  experienced  any  ill  effects.  In 
^Boston  Med.  and  Surg.  Journal.,  Feb  -7,  1878. 


HISTORY. 


33 


the  New  York  Medical  Record,  of  March  5th,  1875, 
Col.  Dodge  and  Asst.  Surgeon  Janeway  report  some 
valuable  statistics  of  the  invariably  fatal  effects  conse- 
quent upon  the  bites  of  skunks  in  certain  regions  of  the 
West.  ^Mn  the  especial  region  of  the  valley  of  the 
Arkansas  river,  the  bite  of  the  skunk  is  reported  to  give 
rise  to  hydrophobia  in  man,  although  the  animal  itself 
be  in  a normal  condition  at  the  time,  and  its  bite  is  fol- 
lowed in  the  dog  by  no  bad  eflFects.^^* 

The  annual  death  rate  from  hydrophobia  in  England 
and  Wales  to  a million  persons,  during  18* >8-1876, 
was : — t 

In  1838,  1.6;  in  1839,  1.0;  in  1840,  0.8;  in  1841, 
0.4;  in  1842,  0.9;  in  1847,0  3;  in  1848,0.4;  in  1849, 
1.0;  in  1850,0.7;  in  1851,1.4;  in  1852,0.8;  in  1853, 
0.6;  in  1854,0.9;  in  1855,0.7;  in  1856,0.3;  in  1857, 

0.2;  in  1858,0.1;  in  1859,0.2;  in  1860,0.2;  in  1861, 

0.2;  in  1S62,0.5;  in  1863,0.2;  in  1864,0.6;  in  1865, 
0.9;  in  1866,1.7;  in  1867,0.5;  in  1868,0.3;  in  1869, 

0.8;  in  1870,1.4;  in  1871,2.5;  in  1872,1.7;  in  1873, 

1.2*  in  1874,  2.6;  in  1875,2.0;  in  1876,1.2;  in  1877, 


Deaths  from  hydrophobia  in  Ireland,  during  each  of 
the  years  1838-75 


1838, 

3 

In  1839,  2 

In  1840,  3 

In  1841, 

4 

1842, 

7 

1843,  6 

1844,  7 

1845, 

4 

1846, 

4 

1847,  4 

1848,  5 

1849, 

11 

1850, 

5 

1851,  6 

1852,  2 

1853, 

9 

1854, 

6 

1855,  7 

1856,  4 

1857, 

7 

1858, 

4 

1859,  9 

1860,  4 

1861, 

5 

1862, 

8 

1863,  8 

1864,  7 

1865, 

5 

1866, 

4 

1867,  4 

1868,  3 

1869, 

2 

Boston  Med.  and  Burg.  Journal^  Feb.  7,  1878. 
f Dr.  Dolan,  Op.  cit. 


34 


HYDROPHOBIA. 


1870,  1 1871,  ~ 1872,  ^ 1873,  ~ 

1874,  - 1875,  1 


In  Scotland,  during  the  years  1855  to  1874,  inclusive, 
there  were  only  three  cases  of  hydrophobia  registered. 

In  Prussia,*  according  to  Dietrich,  the  number  of 
deaths  were : — 

In  1844,  20;  in  1845, 15;  in  1846,  28.  From  1820 
to  1834,  inclusive,  there  were  1073  deaths  from  hydro- 
phobia, or  about  71  every  year. 

Austria  appears  to  have  suffered  severely  during  the 
period  from  1830  to  1838,  and  again  from  1839  to  1847. 
The  following  statement  is  interesting,  as  showing  the 
divisions  of  the  empire  in  which  hydrophobia  was  most 
prevalent : — 

Lower  Austria 22 


1830  to  1838.  1839  to  1847. 

....  29 


Styria 


Silesia . 


Yen 


ice 


..  0 ... 

2 

..  7 ... 

4 

..  0 ... 

1 

..  0 ... 

5 

..  33  ... 

20 

..  0 ... 

1 

..  8 ... 

9 

..  48  ... 

34 

..  18  ... 

8 

. 5 ... 

3 

..  63  ... 

81 

..  12  ... 

24 

..122  ... 

14 

..107  ... 

85 

..  54  . .. 

66 

..  83  ... 

57 

589 

449 

■^Fleming,  Op.  cit. 


HISTORY. 


35 


In  the  Washington  Evening  Star^  oi  May  9^  1879,  we 
find  the  following  : — 

“ Hanson  Ross,  a young  colored  man  employed  on  the  farm  of 
C.  F.  Billopp,  near  Upper  Marlboro’,  Prince  George’s  county,  Md., 
died  of  hydrophobia  on  Saturday  last,  in  great  agony.  Ross  was 
bitten  on  the  lefo  hand  by  a dog,  on  April  16th.  Mr.  Billopp  scraped 
the  wound  and  saturated  it  with  ammonia,  and  it  was  afterward 
cauterized  by  Dr.  B.  L.  Bird.  The  next  day  Ross  came  to  this 
city,  where  he  was  treated  for  about  a week,  and  he  returned  to 
his  home.  Old  Fields,  Prince  George’s  county,  apparently  cured. 
About  ten  days  ago,  however,  he  began  to  exhibit  unmistakable 
signs  of  hydrophobia,  and  it  was  found  necessary  to  confine  him, 
and  he  rapidly  grew  worse  until  death  came  to  his  release.” 

Dr.  G.  McDonald,  of  Union,  West  Virginia,  read 
before  the  Medical  Society  of  Virginia,  Oct.  24,  1878, 
the  details  of  a well-marked  case  of  this  malady. 

In  October,  1878,  several  cows  belonging  to  a gentle- 
man living  near  Geneva,  Switzerland,  were  bitten  by  a 
dog:  belono:ingi:  to  the  herdsman.  This  dog;  was  at  once 
fastened,  and  died  in  a few  days  with  the  characteristic 
symptoms  of  rabies.  About  one  month  later,  three  of 
the  cows  that  had  been  bitten  refused  their  food,  a viscid 
saliva  flowed  from  their  lips,  and  their  bellowing  could 
be  heard  at  a great  distance.  Shortly  afterward  some 
paralysis  of  the  hind  limbs  was  noticed,  and  on  the  sixth 
day  they  succumbed,  paralysis  of  the  entire  posterior 
half  of  the  body  being  then  complete.  They  were  not 
at  all  savage, and  showed  no  dis[)Osition  to  bite;  but  the 
accidental  presence  of  a dog  excited  them  in  an  extraor- 
dinary manner.  At  the  end  of  three  months  eleven  had 
fallen  victims  to  the  disease.  The  period  of  incubation 
ranged  between  one  and  two  months. 


36 


HYDROPHOBIA. 


CHAPTER  III. 

PATHOLOGY  AND  MORBID  ANATOMY. 

Capiavacci^*  an  Italian,  was  the  first  anatomist,  we 
believe,  who  published  an  account  of  any  dissections  of 
this  kind.  His  observations,  with  those  of  Zwingems, 
Brechteld,  and  other  writers,  were  republished  in  the 
Sepulchrefumy  and  then  collected  by  Boerhaave,  and  con- 
densed into  a single  aphorism.  ^^The  morbid  phenomena 
discoverable  in  the  body  by  dissection  are  generally  the 
organs  of  deglutition  somewhat  inflamed,  the  lungs 
incredibly  distended  with  blood,  the  heart  full  of  blood, 
the  arteries  full,  the  veins  empty,  blood  in  the  arteries 
extremely  liquid,  and  scarce  coagulating  in  the  air;  all 
the  muscles,  viscera,  brain,  and  spinal  marrow  drier 
than  usLial.^^  {Aphor,,  1140.)  Morgagni  collected  the 
evidence  of  his  time,  and  after  comparing  observations 
with  those  of  Mead,  Plancus,  Fabri,  Brogiani,  etc.,  came 
to  the  conclusion  that  the  seat  of  the  disorder  was  in 
the  nerves  and  brain.  As  far  as  the  visible  appearances 
can  furnish  us  with  data,  the  notes  of  (preceding)  statis- 
tics correspond  in  the  main  with  the  general  observations 
of  experienced  pathologists;  and  though  the  medulla 
oblongata,  spinal  cord,  and  its  membranes,  presented  no 
other  visible  lesion  but  congestion,  yet  as  the  older  anat- 
omists did  not  overlook  the  possibility  of  changes  — 
which  were  not,  perhaps,  apparent  to  the  unaided  vision, 
but  which  the  microscope  might  supply  — so  we  may 
*Dr.  Dolan,  Op.  cit. 


PATHOLOGY  AND  MORBID  ANATOMY. 


37 


more  justly  adopt  this  view.  Dr.  Aitken,  we  knoAV, 
suggested  such  an  hypothesis^  and  before  liim^  Dr.  Cop- 
land* remarked  that  the  absence  of  a lesion  in  these 
parts  has  not  been  satisfactorily  shown,  and  whether  the 
existing  lesion  be  one  of  an  inflammatory  character,  or 
one  interesting  the  ultimate  structure  of  these  parts  in 
such  a manner  as  to  escape  the  detection  of  our  unas- 
sisted senses,  there  are  strong  reasons  for  inferring  that 
some  changes  actually  exist  in  these  situations,  though 
it  may  not  be  limited  to  them,  but  may  extend  to  the 
related  and  associated  nerves,  and  even  to  the  parts  sup- 
plied by  these  sources,  and  by  those  nerves. 

Dr.  Holland,  of  Cork,  consulted  393  monographs, 
besides  an  immense  number  of  reports  in  various  jour- 
nals, and  selected  what  he  believed  120  cases  of  genuine 
rabies.  From  his  notes  Dr.  Shinkwin  published  some 
valuable  and  interesting  lectures  in  the  Dublin  Medical 
Press  of  1865,  and  we  give  an  analysis  of  the  patholog- 
ical appearances  observed  in  these  120  cases. 

The  diseased  condition  which  most  frequently  pre- 
sented itself  was  a congestive,  highly  vascular,  or  inflamed 
state  of  the  pharynx,  which  occurred  nineteen  times,  or 
nearly  once  in  every  six  cases.  He  included  under  one 
head  the  congestion  (probably  venous),  the  state  of  injec- 
tion (probably  arterial),  and  the  inflammation  of  the 
pharynx,  as  the  recorders  did  not  make  any  distinction 
between  these  three  states.  Next  in  points  of  frequency 
is  a similar  state  of  the  mucous  tract,  bronchi,  or  lungs, 
taken  either  separately  or  collectively,  which  presented 
itself  in  18  out  of  the  120  cases;  and  passing  from  the 
■^Article  “Rabies,”  Copland^ s Did.  of  Medicine. 


38 


HYDROPHOBIA. 


mucous  membranes  to  the  state  of  the  brain  and  its  serous 
envelopes  we  find  they  were  congested  13  times^  or  about 
once  in  every  13  cases.  The  mucous  membranes  and 
oesophagus  were  highly  inflamed^  or  vascular,  in  12 
cases,  or  1 in  every  10 ; and  descending  this  tract  to  the 
intestines,  they  are  reported  as  having  been  distended 
with  gas  in  10  cases,  or  1 in  every  12.  Congestion  of 
the  spinal  cord  occurred  7 times ; unusual  fluidity  of  the 
blood,  7 times;  congestion  of  the  membranes  of  the 
brain  without  a similar  state  of  the  brain  substance,  6 
times ; and  vice  versa,  6 times;  while  the  cardiac  end  of 
the  stomach  presented  an  inflamed  appearance  in  an  equal 
number  of  cases,  about  1 in  every  20.  Congestion  of 
the  larynx  and  intestines  was  noticed  5 times,  and  all 
the  viscera  presented  a normal  appearance  in  1 out  of 
every  24  cases. 

Trolliet  in  Nouvea^i^  traits,  de  la  rage/^  gave  as  the 
result  of  his  dissections : Extensive  mischief  in  various 

I 

organs  remotely  situated  from  each  other,  the  chief  of 
which  are  the  changes  in  the  mucous  membrane  of  the 
trachea  and  bronchi,  and  the  membranes  of  the  brain, 
especially  the  pia  mater,  all  of  which  are  infiltrated  with 
red  blood,  from  inflammatory  action.  The  mucous 
membrane  of  the  bronchi  and  trachea,  covered  with  a 
frothy  material  of  a peculiar  kind  which  M.  Trolliet 
supposed  to  be  the  seal  or  vehicle  of  the  specific  virus, 
which,  in  his  opinion,  was  driven  forward  into  the  fauces 
and  intermixed  with  the  saliva  by  each  expiration  from 
the  chest.  The  capillary  vessels  of  the  lungs  congested, 
the  substance  emphysematous,  the  blood  black,  uncoag- 
ulating, and  of  an  oily  appearance ; the  mucous  mem- 


PATHOLOGY  AXD  MOEBID  ANATOMY. 


39 


brane  of  the  mouth  and  pharynx  of  a pale  gray  and 
lubricated  by  a gentle  moisture^  containing  no  saliva  or 
any  frothy  material.  The  salivary  glands^  and  the  sub- 
stance which  covers  them,  afforded  not  the  slightest  ves- 
tige of  inflammation,  nor  of  any  alteration  in  volume, 
color,  or  texture. 

Mayo*  summarizes  the  results  of  post-mortems,  as 
follows  : A slightly  swollen  state  of  the  mucous  glands 
at  the  root  of  the  tongue,  and  a trifling  increase  of  vas- 
cularity, hardly  amounting  to  inflammation,  and  greater 
or  less  in  different  instances,  of  the  mucous  membrane 
of  the  epiglottis,  particularly  at  its  edge,  and  of  the 
upper  part  of  the  larynx  generally.  These  appearances 
alone  are  constant;  of  those  which  follow,  some  are 
always  observed,  so  that  to  a certain  degree  they  are 
alternative.  The  mucous  membrane  of  the  pharynx 
and  of  the  stomach,  one  or  both,  are  often  inflamed  at 
one  or  more  parts,  in  patches  sometimes  of  a bright  red, 
generally  with  less  intensity.  The  membrane  lining 
part  of  the  bronchial  tubes  often  displays  a considerable 
increase  of  vascularity.  There  is  commonly  a slight 
increase  of  vascularity  in  the  brain  and  trifling  eflusion. 
Sometimes  the  anterior  aspect  of  the  medulla  oblongata 
has  great  capillary  vascularity,  attended  even  with 
ecchymosis.  Mayo  believed  it  was  evident  that  these 
appearances,  occurring  with  such  irregularity,  must  be 
considered  as  effects,  as  results  of  the  disturbance  of  the 
nervous  system,  evinced  by  the  convulsive  symptoms, 
although  not  shown  by  any  appreciable  alteration  visible 
to  the  naked  eye.  He  further  believed  that  this  patho- 
* Medical  Gazette,  vol.  xxix,  p.  648. 


40 


HYDROPHOBIA. 


logical  view  was  just,  and  was  rendered  probable  by  the 
consideration  of  cases  which  approached  nearest  in  their 
nature  to  hydrophobia,  as  varieties  of  tetanus,  and  of 
nervous  irritation  from  poisoned  wounds  received  in 
dissection. 

Romberg*  testifies  to  the  following  changes : Conges- 
tion of  the  respiratory  organs,  partial  and  general  redden- 
ing of  the  mucous  membrane,  extending  from  the  glot- 
tis to  the  finest  bronchi;  accumulation  of  frothy  mucous 
fluid,  engorgement  of  the  lungs  with  dark  fluid  blood 
containing  many  air  bubbles  and  lobular  emphysema ; 
the  cavity  of  the  mouth  is  generally  found  to  contain 
much  viscid,  whitish-yellow  mucus.  The  papillae  of  the 
tongue  and  the  mucous  glands  of  the  mouth  and  pha- 
rynx are  often  much  developed  and  prominent.  Some 
patches  of  reddening  and  congestion  of  the  vessels  are 
visible  at  the  pharynx  and  intestines,  and  especially  in 
the  stomach. 

Fleming  thus  writes,  concerning  the  post-mortem 
changes  in  dogs  : The  following  may  be  accepted  as  the 
principal  lesions  noted  in  necroscopical  examination  of 
the  bodies  of  dogs  which  have  died  of  rabies,  some  being 
less  frequent  and  less  marked  than  others,  and  a few 
being  rarely  observed.  There  is  congestion  of  the  brain, 
particularly  at  the  base,  as  well  as  on  the  spinal  cord, 
and  sometimes  a serous  effusion  into  these  organs.  The 
muscular  system  shows  congestion  as  well  as  the  cellular 
tissue,  the  liver,  and  the  kidneys.  The  lungs  are  not 
unfrequently  greatly  gorged  with  blood,  as  in  animals 
that  die  of  asphyxia.  The  spleen  is  also  more  or  less 
^Nervous  Diseases,  vol.  2,  p.  337. 


PATHOLOGY  AND  MORBID  ANATOMY. 


41 


congested,  and  frequently  enlarged.  The  blood  in  the 
vessels  is  black  and  pitch-like,  and  furnishes  little  or  no 
clots.  The  mucous  membranes  exhibit,  perhaps,  the 
most  constant  alterations.  These  are  redness  of  more 
or  less  intensity,  extreme  congestion  of  the  vessels,  thick- 
ening of  the  membrane,  and  hemorraghic  effusion  to  a 
greater  or  less  extent  on  its  surface. 

In  the  Centrallblatt  fur  die  Medicin.  Wissenschaften, 
Kolesem  Koff  reports  the  result  of  the  examination  of 
ten  mad  dogs,  made  in  Rudneff  \s  pathological  labora- 
tory at  St.  Petersburg.  The  parts  examined  were  the 
cerebral  hemispheres,  the  corpora  striata,  thalami  optici, 
cornua  ammonis,  cerebellum,  medulla  oblongata,  me- 
dulla spinalis,  and  the  sympathetic  and  spinal  ganglia. 
The  changes  were  always  most  marked  in  the  ganglia, 
and  were  as  follows:  1.  The  vessels  were  much  dis- 
tended and  filled  with  red  corpuscles.  Here  and  there, 
along  their  course,  were  seen  groups  of  red  corpuscles, 
and  round  indifferent  elements  (probably  emigrated 
white  corpuscles)  scattered  in  the  perivascular  spaces. 
The  walls  of  the  vessels  were  spotted  with  hyaloid 
masses  of  various  forms,  sometimes  extending  into  and 
obstructing  the  lumen  of  the  vessel,  like  thrombi.  Not 
far  from  these  were  collections  of  white  and  red  corpus- 
cles. 2.  There  was  found  to  be  a collection  of  round, 
indifferent  elements  in  general  around  the  nerve  cells, 
sometimes  penetrating  into  the  protoplasm  of  the  cells 
to  the  number  of  five  or  eight,  sometimes  in  such  num- 
ber as  quite  to  displace  the  cell-protoplasm.  The  num- 
ber of  migrated  cells  produced  various  changes  in  the 
form  of  the  nerve  elements.  The  nuclei  of  the  cells 


42 


HYDEOPHOBIA. 


were  sometimes  pushed  toward  the  periphery  by  the 
intrusive  elements.  In  other  cases  the  nerve  cells  seemed 
entirely  replaced  by  masses  of  round,  indifferent  corpus- 
cles. These  changes  were  seen  even  in  isolated  nerve- 
cells. 

In  the  Oesterreichische  Vierteljahrsschrift  f ur  wissen- 
schaftliche  Veterindrkunde,ioY  1875,  there  is  a valuable  re- 
port of  the  cases  brought  to  the  Vienna  Imperial  Veterina- 
ry Institute  for  treatment,  including  an  excellent  analysis 
of  the  necroscopical  examinations.  In  the  Transactions 
of  the  Pathological  Society  of  London^  vol.  xxiii,  p.  16, 
1872,  Dr.  Clifford  Allbutt  details  the  following  con- 
ditions in  the  nerve  centres  of  two  patients  who  died 
from  hydrophobia  in  the  Leeds  General  Infirmary. 
The  specimens  were  taken  from  the  cerebral  convolu- 
tions, from  the  central  ganglia,  the  medulla  oblongata, 
and  the  spinal  cord : 1.  Evidences  of  great  vascular 

congestion,  with  transudations  into  the  surrounding 
tissues.  In  all  the  gray  centres  the  vessels  were  seen  in 
various  degrees  of  distention ; their  walls  in  many  cases 
being  obviously  thickened,  and  here  and  there  were  seen 
patches  of  nuclear  proliferations.  There  was  a dimin- 
ished consistence  of  some  of  the  parts,  particularly  of 
the  medulla.  This  seemed  to  be  due  to  serous  infiltra- 
tion and  soddening,  as  has  been  observed  in  the  dog. 
2.  Hemorrhages  of  various  size.  In  many  places  a 
refracting  material  was  visible  outside  the  vessels,  due, 
apparently,  to  coagulated  fibrinous  exudate.  3.  Little 
gaps,  caused  by  the  disappearance  of  nerve  strands, 
which  had  passed  through  the  granular  disintegration 
of  Clarke.  In  addition  to  these  appearances  in  the 


PATHOLOGY  AND  MORBID  ANATOMY. 


43 


nerve  centres,  an  enlarged  spleen  had  been  found.  In 
both  cases  the  parts  appeared  to  be  affected  in  the  follow- 
ing order,  as  regards  severity : 1.  Medulla.  2.  The 

spinal  cord.  3.  The  cerebral  convolutions.  4.  The 
central  ganglia.  This  was  in  accordance  with  the  symp- 
toms presented  during  life,  viz. : — 

1.  Reflex  irritability  in  the  region  of  the  medulla, 
with  no  tetanic  spasms. 

2.  Increasing  irritability  throughout  the  cord,  with 
semi-tetanus. 

3.  Delirium. 

In  the  Proceedings  of  the  New  York  Neurological 
Society,’Muly  7,  1874,  in  the  Physiologiml  and  Medico- 
Legal  Journal,  September,  1874,  p.  169,  also  in  his 
work.  On  Diseases  of  the  Nervous  System,  Dr.  Hammond, 
of  New  York,  gives  an  elaborate  description  of  the 
microscopical  changes  observed  in  the  case  of  McCor- 
mick, who  died  from  hydrophobia,  June  25,  1874. 
These  changes  were:  Fatty  degeneration  of  nerve  cells 
in  the  cortical  substance  of  the  brain,  in  the  roots  of  the 
pneumogastric,  hypoglossal,  and  spinal  accessory  nerves, 
and  in  the  upper  portion  of  the  spinal  cord.  Dr.  Rus- 
sell, in  objecting  to  these  conclusions,  says  : Dr.  Ham- 
mond considers  these  appearances  almost  identical  with 
those  in  two  cases  examined  by  Dr.  Clifford  Allbutt  and 
reported  to  the  London  Pathological  Society  in  1872, 
in  which  that  observer  stated  that  there  had  been  noticed 
throughout  all  the  cerebro-spinal  centres,  in  different 
degrees,  congestion,  hemorrhages,  fibrinous  exudations, 
and  little  gaps,  caused  by  the  disappearance  of  nerve 
strands  which  had  passed  through  the  granular  disinte- 


44 


HYDROPHOBIA. 


gration  of  Clarke.^^  Dr.  Hammond  regards  his  own 
observations  as  of  peculiar  ^‘scientific  value  in  determin- 
ing the  pathogeny  of  hydrophobia.^^  I am  unable  to 
agree  with  his  conclusions^  for  the  following  rea- 
sons : — 

1st.  Even  admitting  (which  I do  not)  that  the  lesions 
which  he  reported  were  almost  identical  with  those  de- 
scribed by  Allbutt,  a number  of  other  equally  minute 
examinations  of  the  nervous  centres  and  principal  nerves 
implicated  have  been  made  in  similar  cases  by  experienced 
observers^  without  the  detection  of  any  abnormal  appear- 
ances in  some  instances,  and  only  of  intense  congestion 
in  others. 

The  conclusion,  therefore,  seems  irresistible,  that  the 
morbid  changes  noted  are  not  essential  and  primary  fac- 
tors in  developing  the  train  of  symptoms,  but  are,  in  all 
probability,  secondary  lesions,  resulting  from  the  terrible 
disturbance  which  the  disease  causes  in  the  functions  of 
the  respiratory,  vascular,  and  nervous  systems.  Such 
phenomena  could  hardly,  therefore,  be  of  any  value  in 
determining  the  pathogeny  of  the  affection,  any  more 
than  are  a thousand  and  one  other  morbid  changes  seen 
in  various  organs  after  death  by  hydrophobia,  and  which 
are  well  recognized  as  being  merely  consequential  and 
non-uniform  lesions. 

The  eminent  German  veterinary  professor,  Bollinger, 
in  a recent  treatise  upon  hydrophobia  {Ziemssen’s  CycL), 
does  not  hesitate  to  deny  emphatically  that  any  post- 
mortem observations  yet  made  upon  either  man  or  beast 
are  of  any  value  whatsoever  in  tending  to  elucidate  the 
pathogenic  process  of  hydrophobia.  He  adds,  moreover. 


PATHOLOGY  AND  MOKBID  ANATOMY. 


45 


that  in  herbivorous  animals  especially,  there  is  a com- 
plete  absence  of  all  characteristic  changes, 

2.  Granular  and  fatty  degeneration  of  the  nerve  cells 
are  not  uncommon  pathological  lesions  in  cachectic  con- 
ditions of  the  system  which  do  not  present  any  very 
definite  symptoms.  Such  conditions  might,  therefore, 
in  some  cases,  precede  the  development  of  hydrophobia, 
without,  however,  exerting  more  than  an  auxiliary  in- 
fluence in  its  production. 

3.  Very  extensiv^e  post-mortem  researches  have  been 
made  in  cases  of  rabid  dogs,  without  any  satisfactory  re- 
sults. I have  already  alluded  to  Bruckmiiller^s  investi- 
gations. (Bruckmliller,  after  the  most  careful  post-mortem 
examinations  of  375  rabid  dogs,  during  a period  of  twenty 
years,  arrived  at  the  conclusion  that  the  evidence  fur- 
nished by  dissection  is  of  no  value  in  defining  or  distin- 
guishing the  affection,  and  is  worthless  as  a foundation 
for  any  theory.) 

According  to  Roll,  a distinguished  German  authority, 
the  cadaveric  lesions  observed  in  canine  rabies  offer  a 
certain  similarity  to  those  which  are  the  consequence  of 
acute  poisoning  by  narcotic  substances.  In  this  connec- 
tion I may  say  that  upon  visiting  McCormick,  two  hours 
before  death,  he  appeared,  both  to  Dr.  Hammond  and 
myself,  laboring  decidedly  under  the  narcotism  of  atro- 
pine, of  which,  as  I was  then  informed  by  the  attending 
physician.  Dr.  Hadden,  several  large  doses  had  been 
administered.  The  most  recent  pathological  investiga- 
tions of  hydrophobic  cases  fail  to  throw  any  further 
light  upon  the  question  whether  the  lesions  detected  in 
the  nervous  centres  are  pathognomonic  of  the  disease,  or 


46 


HYDROPHOBIA. 


are  merely  changes  such  as  might  be  due  to  tetanus  or 
any  other  affection  producing  intense  disturbance  of  the 
nervous  system.  Benedikt,  of  the  Vienna  Imperial 
Veterinary  School,  availing  himself  of  a long  continued 
epizooty  of  rabies  in  and  around  Vienna,  during  1873- 
4,  has  made  numerous  preparations  of  a number  of  ani- 
mals which  were  affected.  The  pathological  changes 
were  studied  by  making  seven  separate  vertical  sections 
through  the  hemispheres;  and  the  alterations  w^ere  so 
striking  that  Benedikt  is  of  opinion  they  could  have 
been  overlooked  only  through  imperfect  methods  of  in- 
vestigation. In  the  first  place,  he  notes  an  abnormal 
distention  of  the  meningeal  vessels,  and  the  accumulation 
around  them  and  in  the  meshes  of  the  pia  mater  of  in- 
flammation corpuscles,  together  with  a nucleated  exuda- 
tion. This  was  strongly  refractive  of  light,  was  color- 
less, and  under  high  magnifying  powers  was  seen  to 
consist  of  punctiforrn  nuclear  substance  (granular  disin- 
tegration). Striking  changes  were  observed  in  the  gray 
matter  of  the  convolutions,  and  in  other  parts  of  the 
nervous  centres.  One  of  the  coarser  changes  was  the 
presence  of  numerous  holes  or  spaces,  which,  when  mag- 
nified eighty  or  ninety  diameters,  were  seen  to  be  filled 
with  a material  which  also  refracted  light.  This  mass, 
under  high  microscopic  powers,  consisted  of  a granular 
or  nuclear  substance,  in  which  were  single  hyaloid  and 
colorless  corpuscles  of  the  size  of  the  distended  nucleus 
of  a blood  corpuscle.  Inflammatory  corpuscles  were  to 
be  seen  in  both  masses.  In  the  larger  spaces  nerve 
cells  were  found.  Benedikt  further  describes  a peculiar 
condition  of  the  hardened  brain,  especially  in  the  finer 


PATHOLOGY  AND  MORBID  ANATOMY. 


47 


sections.  The  slightest  pressure  forced  out  upon  the  sur- 
face shining  masses  which  proved  to  be  myelin  (colloid?). 
These  were  often  found  lying  detached  on  the  surface  of 
the  section,  and  presented  a greenish  lustre.  He  states, 
however,  that  he  has  seen  the  same  in  the  spinal  cord  of 
a horse  which  had  suffered  from  rheumatic  tetanus,  and 
regarded  it  as  a softening  and  chemical  alteration  of  the 
cord.  Meynert  has  also  lately  made  a microscopical  ex- 
amination of  the  nervous  system  of  two  children  who 
died  from  hydrophobia.  The  blood  vessels  of  the  spinal 
cord  were  distended,  and  their  walls  were  undergoing 
amyloid  degeneration,  and  the  adventitious  tissue  of  some 
of  them  showed  nuclear  proliferation.  A portion  of  the 
fibres  was  surrounded  by  tumefied  resisting  medullary 
substance,  which  was  partially  in  a state  of  degenera- 
tion, and  the  cylinder  axis  had  disappeared.  These  al- 
terations were  most  conspicuous  in  the  lumbar  portion  of 
the  cord.  The  connective  tissue  of  the  posterior  portion 
of  the  cord  was  hypertrophied  by  an  excessive  enlarge- 
ment of  the  stellate  bodies.  Its  vessels  were  engorged, 
and  in  a state  of  partial  amyloid  degeneration.  Molecu- 
lar and  sclerotic  changes  had  taken  place  in  the  nerve 
cells  of  the  cortical  matter.  Meynert  considered  the 
spaces  or  holes  observed  by  Benedikt  as  a result  of  the 
process  employed  in  preparing  the  specimen  for  examina- 
tion.’^ Haller  asserts  that  he  has  discovered  in  the  blood 
of  hydrophobic  animals  a micrococcus,  which,  when 
cultivated,  is  transformed  into  a cryptogram,  to  which 
he  gives  the  name  Lyssophyton.  This  assertion,  how- 
ever, needs  further  proof. 

Of  the  pathology  of  hydrophobia.  Dr.  Hammond 


48 


HYDROPHOBIA. 


writes  : Is  hydrophobia  a disease  of  the  nerve  centres, 
or  a blood  disease  ? I suppose  it  is  utterly  impossible, 
in  the  present  state  of  our  knowledge,  to  answer  such  a 
question.  It  may  start  as  a blood  disease  and  end  as  a 
nerve  disease.  Blood  diseases  lead  to  structural  changes 
of  various  organs  of  the  body,  and  the  nerve  centres  are 
likewise  involved  to  a considerable  extent.  Is  it  not 
worth  while  to  call  attention  to  the  numerous  instances 
of  blood  diseases  which  produce  structural  changes? 
Hydrophobia  may  be  a blood  disease,  and  yet  afterward 
be  succeeded  by  changes  in  the  nerve  centres.  It  is  not 
necessary  to  suppose  that  hydrophobia  is  a nerve  disease 
from  the  beginning;  it  is  perfectly  possible,  however, 
that  it  may  be,  and  there  are  a great  many  instances 
which  can  readily  be  adduced  in  proof  of  this  assertion. 
Take  tetanus,  for  example.  Very  few  pathologists  pretend 
to  say  that  tetanus  is  a blood  disease.  It  is  a disease 
propagated  through  the  nerve  tissues,  starting  from  injury 
of  a peripheral  nerve,  and  inducing  structural  changes 
in  the  spinal  cord.  Dr.  Lockhart  Clarke  has  ascer- 
tained in  a number  of  cases  that  the  essential  condition 
of  tetanus  is  a granular  degeneration  of  the  cord,  and 
that  is  probably  only  the  beginning  of  the  fatty  degen- 
eration I find  in  hydrophobia,  and  yet  there  is  no  suspi- 
cion of  blood  poisoning  in  tetanus.  Hydrophobia  pre- 
sents manv  analogies  to  tetanus,  not  only  in  its  morbid 
anatomy  but  in  its  natural  history.  Epilepsy  can  be 
caused  by  injury  to  the  peripheral  nerves.  I had  a case, 
some  years  ago,  of  a lady  who  wounded  her  thumb,  and 
six  months  afterward  she  had  epileptic  paroxysms,  Avhich 
were  preceded  by  an  aura  originating  in  the  cicatrix. 


PATHOLOGY  AND  MORBID  ANATOMY. 


49 


And  if  epflepsy,  which  is  another  one  of  the  spasmodic 
diseases,  can  be  induced  by  a single  wound,  why  not 
hydrophobia?  So  that  we  have  examples  of  analogous 
diseases  caused  by  wounds  of  nerves,  without  the  neces- 
sity of  supposing  the  blood  to  be  primarily  affected. 
Still,  there  cannot  be  much  doubt  that  the  poison  in  the 
saliva,  and  not  the  wound  made  by  the  animahs  teeth,  is 
the  essential  influence  producing  hydrophobia.  It  is  not 
at  all  certain,  however,  that  the  latter  may  not,  in  some 
cases,  produce  a modification  of  the  characteristics  of  the 
disease,  perhaps  causing  those  tetanoid  phenomena  which 
are  occasionally  present.  The  nature  of  the  virus  is 
unknown.  It  is  probably  of  the  nature  of  a ferment ; 
but  this  cannot  be  satisfactorily  proved/^ 

^^Trolliet*  maintained  that  the  saliva  se  possesses 
no  contagious  quality ; only  so  when  mixed  with  the 
frothy  material  driven  out  from  the  bronchi,  which  con- 
stitutes the  vehicle  transmitting  the  virus.  His  opinion 
was  founded  upon  the  absence  of  any  evidence  of  disease 
in  the  salivary  glands,  upon  the  morbid  changes  always 
existing  in  the  bronchi,  and  upon  analogies  furnished  by 
other  contagious  diseases,  as  gonorrhoea,  smallpox  or 
syphilis.  His  distinction,  however,  is  of  no  practical 
importance.  Magendie  considered  that  he  had  demon- 
strated the  non-inoculability  of  the  disease  by  any  other 
material  of  the  animahs  body  than  the  saliva  ; but  Hert- 
wig  has  since  apparently  proved,  by  experiment,  that 
the  blood,  and  therefore  most  of  the  tissues,  contain,  to 
some  extent,  the  poisonous  element.  The  saliva,  as 
deinonstrated  by  Hertwig,  retains  its  noxious  properties 
* Dr.  Russell.  Op.  cit. 


50 


HYDROPHOBIA. 


for  at  least  fifteen  hours  after  death,  and  it  is  asserted 
by  Schenck  that  the  disease  has  been  produced  by 
wounds  from  sabres  with  which  rabid  dogs  had  been 
dispatched  years  previously.’^ 

With  regard  to  the ‘Mysses”  insisted  upon  by  Maro- 
chetti,  Fleming  says  ^^that  they  have  been  sought  for 
in  vain  by  the  veterinarians,  Bouley,  Barthelmy,  Renault, 
Colin,  Leblanc,  Delafond,  Rey,  Lafosse,  Haubner,  Pill- 
wax,  Roll,  Eckel  and  other  careful  comparative  patholo- 
gists. Even  when  they  or  similar  appearances  do  exist, 
no  value,  it  would  appear,  can  be  placed  upon  them;  as, 
according  to  other  veterinarians,  among  them  Prinz, 
— they  may  be  observed  in  healthy  dogs;  and  Spinola 
says  he  has  found  them  in  dogs  affected  with  anthrax. 
Saint-Cyr  mentions  having  found,  in  a horse  that  died 
rabid,  the  sublingual  glands  congested,  and  a patch  of 
ecchymosis  the  size  of  a twenty-centime  piece  at  the  base 
of  each  sublingual  duct.  Bruckiniiller  found  a deep 
ulcer  at  the  root  of  the  tongue  of  a mad  dog;  in  another 
he  observed  the  lymphatic  glands  of  the  throat  very  red 
and  swollen.  And  Peuch  examined  very  carefully  a 
dog  that  had  perished  from  rabies,  and  found  the  la- 
ryngeal mucous  membrane  slightly  inflamed  and  covered 
with  mucus.  On  the  right  side  of  the  tongue,  and  a 
little  behind  the  base  of  that  organ,  beneath  the  epithe- 
lium, were  two  pustules  of  a white  color,  and  different 
in  size;  one  was  of  the  volume  of  a grain  of  millet,  the 
other  smaller.  They  were  surrounded  by  a slight  in- 
flammatory areola,  and  both  showed  in  the  centre  a 
minute  opening  visible  to  the  naked  eye  ; inspected  with 
a lens,  the  opening  appeared  to  be  that  of  the  lingual 


PATHOLOGY  AND  MORBID  ANATOMY. 


51 


gland.  Anteriorly  there  were  four  pustules— two  on  the 
fraenuin  of  the  tongue.  They  were  about  the  size  of  a 
grain  of  millet;  each  had  an  inflammatory  circle  sur- 
rounding it,  and  when  they  were  compressed  a few 
drops  of  liquid  escaped  and  looked  like  pus.  On  the 
frsenum  of  the  tongue  of  the  left  side  was  a seventh  pus- 
tule, quite  isolated,  and  the  most  developed  and  con- 
spicuous. It  Avas  as  big  as  a large  millet  seed,  appeared 
to  be  perfectly  closed,  and  was  circumscribed  by  the  in- 
flamed ring,  like  the  others.  The  epithelium  covering  it 
was  thin  and  slightly  raised  by  a purulent  fluid,  which 
was  not  in  sufficient  quantity  to  practice  an  inoculation 
with.  In  twenty-seven  examinations  of  dogs  that  had 
died  from  rabies,  Peuch  found  lesions  of  the  tongue  in 
fourteen,  twelve  as  ulcerations,  and  two  with  pustules. 
In  this  connection  it  must  not  be  forgotten  that  Maro- 
chetti  did  not  contend  for  the  existence  of  the  lyssi  after 
death,  but  only  asserted  that  they  were  to  be  searched 
for  during  the  incubation  of  the  malady — a circumstance 
that  appears  to  have  been  overlooked  by  those  who  have 
contended  for  and  against  the  presence  of  these  vesicles.^^ 
Dr.  Coates,  according  to  Dr.  Dolan,  has  described  the 
microscopical  appearance  in  two  of  the  cases  which  oc- 
curred at  Glasgow.  The  coarse  examination  of  the 
principal  organs  of  the  nervous  system  showed  that  the 
veins  of  the  encephalon  were  distended  with  blood,  that 
the  surfaces  of  the  arachnoid  were  smeared  with  blood 
tinged  with  fluid  over  the  hemispheres,  and  that  there 
were  a few  drachms  of  similar  fluid  in  the  ventricles. 
Microscopical  examination  of  the  cicatrix  of  the  original 
wound  showed  that  the  skin  and  subcutaneous  fat  were 


52 


HYDROPHOBIA. 


infiltrated  with  round  cells ; the  blood  vessels  presented 
in  their  internal  wall  transparent  globular  bodies,  like 
drops  of  an  exuded  fluid.  In  many  parts  of  the  cord 
and  medulla  oblongata  accumulations  of  round  cells 
were  found  in  the  perivascular  spaces  of  the  medium 
sized  vessels,  and  similar  cells  were  also  found  around 
the  ganglion  cells.  In  all  parts  of  the  system  there  were 
numerous  amyloid  bodies,  but  only  one  hemorrhage  was 
discovered.  Still  following  Dr.  Dolan,  we  learn  that  on 
May  15th^  1877,  Dr.  Gowers  exhibited  before  the  Patho- 
logical Society  of  London  an  extensive  series  of  micro- 
scopical sections,  illustrating  the  changes  in  the  medulla 
oblongata  and  spinal  cord  in  four  cases  of  rabies.  I'or 
two  of  these,  which  occurred  at  Sheffield  and  Hertford, 
he  was  indebted  to  Lockhart  Clarke,  and  for  the  other 
two,  to  Dr.  Wickham  Legg.  The  changes  found  re- 
sembled, in  the  main,  those  which  have  been  described 
by  Benedikt  as  occurring  in  the  convolutions  of  the  dog, 
and  by  Dr.  Coates  in  the  lower  centres  in  man.  In  all 
four  cases  the  vessels  of  the  gray  matter  were  greatly 
distended,  the  distention  being  greater  in  the  medulla, 
near  the  gray  nuclei  in  the  lowest  part  of  the  fourth 
ventricle.  In  three  of  the  cases  the  larger  veins  in  this 
position  presented  aggregations  of  small  cells  within  the 
perivascular  lymphatic  sheath.  These  were,  in  some 
cases,  as  a single  layer,  in  other  cases  densely  packed,  so 
as  to  compress  the  vessels  they  surrounded.  In  a few 
places  the  cells  extended  beyond  the  limits  of  the  sheath. 
In  most  parts  similar  cells  were  scattered  through  the 
tissue,  among  the  nerve  elements,  and  in  some  places, 
chiefly  in  and  near  the  hypoglossal  nuclei,  there  were 


PATHOLOGY  AND  MORBID  ANATOMY. 


53 


dense  collections  of  these  cells^  constituting,  in  fact,  mili- 
ary abscesses.  Similar  smaller  collections  were  seen 
among  the  fibres  of  origin  of  the  hypoglossal  and  glosso- 
pharyngeal nerves.  Adjacent  to  many  vessels  were 
areas  of  granular  degeneration.^^  In  two  cases  many 
of  the  larger  vessels,  chiefly  veins,  contained  clots,  parts 
of  which  were  evidently  of  ante-mortem  formation, 
portions  of  the  clots  being  different  from  the  rest,  darker, 
granular,  or  spongy  in  aspect.  By  some  of  these  the 
appearance  of  embolism  was  closely  simulated.  Atten- 
tion was  drawn  to  the  indications  of  formations  in  situ 
afforded  by  the  gradation  between  the  normal  and  the 
altered  clot,  and  by  the  curved  lines  of  pressure  to  which 
the  clot  had  been  exposed  immediately  after  its  forma- 
tion. One  specimen  presented  thickening  of  the  inner 
coat  of  a vein,  opposite  the  older  part  of  a clot,  and  the 
clot  was  reduced  in  size  correspondingly,  as  if  formed 
secondarily  to  the  change  in  the  inner  coat  of  the  vein. 
In  this  vessel  there  were  round  cells  in  the  perivascular 
sheath,  and  leucocytes  within,  accumulated  in  the  old 
clot  and  within  the  substance  of  the  swollen  inner  coat, 
affording  strong  evidence  that  the  cells  outside  were  also 
migrated  corpuscles.  The  nerve  cells  presented  com- 
paratively slight  changes,  being  merely  slightly  swollen 
and  granular  in  some  places,  and  surrounded  with  gran- 
ular degeneration  here  and  there.  These  changes  were 
most  intense  in  and  about  the  hypoglossal,  pneumogas- 
tric,  and  glosso-pharyngeal  nuclei,  slighter  in  the  nuclei 
of  the  auditory,  facial  and  fifth  nerves,  slighter  also  in 
the  cord,  and  still  slighter  in  the  upper  part  of  the  pores. 

Dr.  Clifford  Allbutt  has  also  found  still  less  definite 


54 


HYDKOPHOBIA. 


changes  most  distinct  in  the  medulla.  In  Dr.  Gower’s 
cases  the  change  reached  its  maximum  in  the  region  of  the 
respiratory  centre”  in  the  medulla^  which  includes  that 
prolongation  downward  of  the  facial  nucleus  which  sub- 
serves the  movements  of  the  lips.  The  paroxysms  of 
hydrophobia  are  paroxysms  of  respiratory  spasms.  In 
the  case  in  which  the  change  in  the  respiratory  centre 
was  most  intense,  the  paroxysms  consisted  of  spasm  of 
the  diaphragm,  and  an  inspiratory  effort,  in  which  the 
clavicles  almost  touched  the  lower  jaw,  and  the  lips  were 
pressed  against  the  teeth.  Further  evidence  of  the  over 
action  of  the  hypoglossal  nucleus,  in  which  the  changes 
were  so  marked,  was  afforded  by  one  case  in  which  a 
noise  as  of  the  tongue  being  smacked  against  the  roof 
of  the  mouth  occurred  at  the  commencement  of  each 
spasm.  Dr.  GoWers  concluded  by  alluding  to  the  diffi- 
cult question,  whether  these  vascular  changes  are  the 
initial  lesion  in  the  nerve  centres,  or  are  secondary  to 
the  irritation  of  the  nerve  elements  by  the  blood  poison. 
It  was  certain  that  embolism  played  no  part  in  the  pro- 
cess ; the  coagulation  in  vessels  was  also  not  essential, 
while  in  one  case  the  absence  of  cell  infiltration  showed 
that  dilatation  might  be  the  only  morbid  state  of  the 
vessels.  On  the  other  hand,  the  changes  in  some  of  the 
clots,  in  cases  in  which  the  symptoms  lasted  only  three 
days,  showed  that  considerable  vascular  changes  must 
have  occurred  very  early  in  the  disease.  Though  we 
have  acquired  new  and  important  data  by  these  obser- 
vations, and  are  progressing  in,  we  believe,  the  right 
direction  to  a more  complete  knowledge  of  the  true 
pathology  of  rabies,  still  we  cannot  affirm  positively 


PATHOLOGY  AND  MOPBID  ANATOMY. 


55 


that  we  have  found  a characteristic  lesion  pathognomonic 
of  it.  There  are  many  difficulties  in  the  way,  and 
especially  incubation^  the  period  of  which  varies  so 
much^  and  about  which  there  are  so  many  theories. 
Dr.  Barry,  in  his  Experimental  Researches^  rejects  the 
notion  that  the  hydrophobic  poison  is  taken  up  and 
mixed  with  the  blood  after  the  manner  of  other  sub- 
stances similarly  circumstanced,  and  that  it  does  not 
produce  its  peculiar  effects  until  after  it  has  wandered 
through  the  penetralia  during  forty  days,  or  longer,  as 
directly  opposed  to  all  analogy. 

Dr.  Dolan  thus  sums  his  conclusions : — 

1.  That  the  phenomena  of  rabies,  as  evinced  by  mor- 
bid anatomy,  depend  on  structural  alterations  in  the 
medulla  oblongata  and  spinal  cord,  influenced  by  a spe- 
cific virus,  the  modus  operandi  of  which  is  yet  involved 
in  obscurity. 

2.  That  the  special  morbid  appearances  found  are 
quite  in  accordance  with  this  belief  in  fact. 

3.  That  the  absence  of  some  of  the  special  appearances 
do  not  invalidate  this  assertion. 

4.  That  this  view  is  supported  by  analogy  from  those 
diseases  with  which  rabies  has  been  confounded. 

5.  That  further  accurate  post-mortem  notes  are  neces- 
sary to  fill  up  the  lacunae,  or  missing  links. 

-6.  That  as  the  microscope  has  confirmed  the  accuracy 
of  the  hypothesis,  and  thrown  a flood  of  light  on  the 
nature  of  the  structural  alterations  foreshadowed  by  the 
older  pathologists,  so  we  may  reasonably  hope  treatment 
will  proportionately  advance,  and  that,  guided  by  the 
light  of  a more  advanced  pathology,  we  may  at  least 


56 


HYDROPHOBIA. 


be  able  to  place  rabies  in  the  category  of  curable  com- 
plaints. 

The  question  as  to  whether  the  lesions  of  the  nerve 
centres  are  primary  or  secondary  to  a blood  poison  is  as 
yet  sub  judice,  but  from  a very  careful  analysis  of  the 
various  necroscopical  reports,  I am  strongly  of  the  opin- 
ion that  future  investigations  will  point  to  the  existence 
of  a blood  ferment  as  the  exciting  factor.  That  this 
ferment  is  of  a nature  to  inhibit  the  functions  of  the 
oxygen  carriers  of  the  blood,  altering  the  chemical  and 
physiological  character  of  the  red  corpuscles  and  greatly 
interfering  with  the  integrity  of  the  blood  plasma;  and 
just  in  proportion  as  we  shall  direct  our  treatment  to 
such  conditions,  by  the  free  administration  of  pure  oxy- 
gen, so  will  the  measure  of  our  success  be. 


INCUBATION. 


57 


CHAPTER  IV. 

INCUBATION : INFLUENCE  OF  AGE^  SEX  AND  CLIMATE. 

The  literature  of  hydrophobia  furnishes  us  with  noth- 
ing' definite  regarding  the  period  of  incubation.  The 
duration  is  exceedingly  variable^  ranging  from  three  days 
to  seven  years.  The  poison  is  deposited  within  the  body 
by  means  of  a wound  from  a rabid  animal^  or  by  con- 
tact of  the  morbid  saliva  with  an  abraded  surface.  The 
wound  generally  seems  to  heal  by  the  first  intention.^^ 
At  this  period  the  virus  may  lie  concealed  for  a length 
of  time,  until  some  exciting  cause  sets  it  free  upon  its 
errand  of  destruction.  Watson  thinks  that  it  may  be 
inclosed  in  a nodule  of  lymph,  or  detained  in  temporary 
union  with  some  of  the  tissues.  Virchow  has  compared 
the  action  of  the  poison  to  that  of  a ferment,  fresh  par- 
ticles of  which  during  their  liberation  from  the  seat  of 
injury  are  being  constantly  conveyed  into  the  blood,  pro- 
ducing through  the  medium  of  the  circulation  the  specific 
effect  upon  the  nervous  system.  From  Dr.  Dolan  we 
learn  ^^That  Dioscorides,  Dios.,  lib.  11,  c.  12,  says  that 
the  symptoms  come  on  in  about  forty  days,  but  in  some 
cases  not  until  after  six  months,  or  even  a year,  but  he 
mentions  writers  who  assert  that  persons  have  been 
attacked  after  seven  years.^^ 

Galen,  Comment.,  2,  tome  viii,  p.  735,  quotes  a case 
with  a period  of  incubation  of  one  year. 

Paul  iEgineta,  Comment.,  lib.  5,  c.  3,  gives  forty  days 
to  six  months. 


58 


HYDKOPHOBIA. 


Varignan^  Varig.  Tract. y p.  127,  asserts  that  the 

poison  may  remain  latent  for  four  days,  a week,  a month, 
or  six  months,  or  a year. 

Fernelius,  De  Morbis  Cont.y  lib.  ii,  c.  14,  remarks 
that  the  effects  may  be  manifested  from  the  twentieth 
day  to  a year. 

Ambrose  Par6,  b.  21,  p.  505,  says  that  the  same  poison 
will  manifest  itself  at  different  periods  in  different  con- 
stitutions. 

Vander  Wiel,  Observ.,  No.  100,  p.  431,  agrees  in  the 
foregoing. 

Claude  de  Choisel  speaks  of  thirty  days  after  the  bite 
as  the  usual  period,  and  Dr.  Mead,  in  his  work  on 
Poisons y^  is  of  the  same  opinion. 

Lommius,  Lommii  Med.  Obs.y  lib.  1,  p.  64,  states  that 
the  disease  has  been  observed  in  fourteen  and  forty  days, 
and  after  six  and  seven  months. 

Morgagni,  in  Epist.  viii,  sec.  21,  relates  a case  in 
which  the  period  of  incubation  was  twenty  years. 

Webster,  Hamilton,  and  Boerhaave  mention  a similar 
lapse  of  time. 

Holland,  in  his  Notes,  and  Shiakwin’s  Lectures,  Dub- 
lin Med.  Press,  1865,  p.  390,  arrived  at  the  following 
calculations,  from  an  analysis  of  120  cases: — 

The  shortest  interval  between  the  bite  and  the  first 
symptom  was  twelve  days;  the  longest,  334  days;  the 
average  period  of  incubation  was  sixty-one  days,  eighteen 
hours. 

The  shortest  interval  between  the  bite  and  the  death 
was  fourteen  days,  eighteen  hours;  the  longest,  335 J 
days ; the  average,  sixty-three  days,  seventeen  hours  and 
twelve  minutes 


IXCUBATION. 


59 


The  least  number  of  hours  from  the  occurrence  of  the 
first  symptom  to  deaths  in  these  cases,  were  eighteen 
hours;  the  greatest  interval,  201  hours;  and  the  average 
duration  of  the  symptoms  was  seventy  hours,  forty-eight 
minutes. 

Thamhayn,  in  Sohmidfs  Jahrbilcherj  1859,  gives  the 
following  periods  of  incubation  in  two  hundred  and 
twenty  cases : — 


In 

2 

cases. 

3 days, 

in 

27 

cases. 

5 

weeks. 

a 

2 

u 

4 

U 

(( 

37 

cc 

6 

cc 

u 

2 

(( 

9 

U 

u 

17 

cc 

7 

cc 

3 

cc 

10 

(6 

u 

8 

cc 

8 

cc 

(( 

1 

(( 

11 

4( 

u 

11 

cc 

9 

cc 

iC 

1 

(C 

12 

(i 

iC 

7 

cc 

10 

u 

iC 

1 

a 

15 

U 

cc 

5 

cc 

11 

cc 

iC 

2 

C( 

17 

U 

iC 

12 

cc 

13 

CjC 

u 

2 

u 

18 

i( 

(( 

3 

cc 

14 

cc 

u 

4 

(( 

19 

C( 

a 

4 

cc 

15 

cc 

(( 

9 

(( 

21 

U 

n 

7 

cc 

16 

cc 

(( 

16 

(C 

4 weeks. 

u 

6 

cc 

5 

months, 

(( 

4 

(( 

6 1 

months, 

(C 

1 

3 

cc 

12 

cc 

i( 

3 

u 

7 

u 

6( 

1 

cc 

15 

cc 

(C 

1 

(( 

8 

a 

U 

2 

cc 

18 

cc 

a 

1 

(( 

9 

6( 

CC 

1 

cc 

24 

cc 

6( 

2 

a 

10 

(( 

CC 

1 

cc 

26 

cc 

(i 

1 

u 

11 

(( 

1 

after 

14 

years. 

and  1 after  5|  years. 

In  the  EncycL  BriL,  Art.  Hydrophobia,^^  Boudin 
gives  the  following  analysis  of  sixty-nine  cases . — 

In  14,  1 month ; in  41,  1 to  3 months;  in  8,  4 to  6 
months;  in  6,  7 to  12  months. 


60 


HYDROPHOBIA. 


In  147  cases,  Tardieu  arrived  at  the  following  con- 
clusions : — 

In  26,  1 month;  in  19,  3 to  6 months;  in  93,  1 to  3 
months;  in  9,  6 to  12  months.  In  the  London  Medical 
Gazette  for  1844,  Caesar  Hawkins  gives  as  his  analysis 
of  130  cases : — 

In  17,  18  to  30  days  ; in  23,  60  to  90  days;  in  63, 
30  to  59  days;  in  9,  90  to  120  days.  After  this  he  goes 
on  to  say,  the  symptoms  developed  at  various  periods, 
one  or  two  in  each  month,  the  5th,  6th,  7th,  and  so  on, 
up  to  the  19th,  the  last  case  occurring  under  Mr.  Nourse’s 
care.  This  is  the  latest  time  at  which  rabies  can  be 
fairly  said  to  have  been  known  ; there  is,  indeed,  a case 
of  Dr.  Bardsley,  in  which  it  is  said  to  have  been  pro- 
duced twelve  years  before,  but  it  appears  most  improb- 
able that  this  was  really  the  case.^^  He  asserted  that 
from  six  weeks  to  three  months  was  the  time  in  which 
almost  all  the  cases  of  rabies  had  been  seen.  In  refer- 
ence to  the  case  of  Bardsley,  Dr.  Elliotson,  in  the  ion- 
don  Medical  Gazette  for  1833,  observes  that  there  is  a 
doubt  about  its  genuineness.  He  believed  that  the 
average  interval  was  from  one  to  two  months.  Elliotson 
had  six  or  eight  cases  in  London,  and  mentions  the  in- 
stance of  two  little  girls  who  were  bitten  on  the  face  by 
a rabid  dog.  At  the  expiration  of  from  six  weeks  to  two 
months  the  girl  who  was  bitten  second  was  attacked 
and  died,  but  the  other  sister  escaped.  Dr.  Parry 
doubts  the  genuineness  of  Bardsley’s  case.  Lawrence, 
in  the  London  Medical  Gazette,  1829,  tells  us  that  there 
is  a latent  period,  tolerably  definite  and  regular,  resemb- 
ling, somewhat,  that  of  scarlet  fever,  smallpox  and 


INCUBATION. 


61 


measles,  and  generally  speaking,  incubation  extends  be- 
tween thirty  and  forty  days.  He  also  alludes  to  the 
case  published  by  Bardsley  in  the  3Iemoirs  of  the  3Ian- 
chester  Literai'y  and  Philosophical  Society.  Romberg  has 
shown,  from  an  analysis  of  sixty  authentic  observations, 
that  the  shortest  period  was  fifteen  days,  the  longest  from 
seven  to  nine  months,  and  the  average  period  from  four 
to  seven  weeks.  He  remarks  that  the  same  infection 
presents  diflTerences,  independent  of  age,  or  sex,  or  the 
locality  of  the  injury,  for  in  thirteen  cases  described  by 
Trolliet,  who  had  been  bitten  on  one  day  by  a mad  wolf 
bitch,  the  symptoms  developed  in — 

6 between  the  15th  and  30th  day. 

4 30th  40th 

2 ''  40th  53d 

And  in  one  in  three  months  and  eighteen  days  after 
the  bite. 

Fleming  informs  us  that  in  224  cases  noted  in  F ranee — 

In  40,  incubation  was  less  than  a month. 

In  143  from  1 to  3 months. 

In  30  from  3 to  6 months. 

In  21  from  6 to  12  months. 

The  mean  duration  of  the  latent  period,  from  Rou- 
cheFs  analysis  of  cases  that  occurred  in  Algiers,  has 
been  fifty-one  days,  the  ordinary  minimum  thirty  days, 
the  maximum  three  months. 

Fleming  also  furnishes  us  with  Bouley^s  statistics  of 
129  fatal  cases,  the  period  of  incubation  being  given  in 
106  : in  73,  rabies  developed  in  60  days;  in  33,  up  to 
the  eight  month. 

Trousseau  informs  us  that  the  disease  generally  shows 


62 


HYDROPHOBIA. 


itself  in  man  from  one  to  three  months  after  the  inflic- 
tion of  the  bite ; that  cases  are  rare  after  three  months, 
and  still  more  rare  from  the  sixth  to  the  twelfth  month, 
and  in  his  opinion,  from  the  statistical  observations  we 
have,  the  authenticity  of  cases  reported  as  occurring  after 
a year  might  be  almost  disputed. 

Bouley  concludes,  from  his  statistics,  that  after  two 
months  immunity  may  be  looked  for,  though  the  dan- 
ger has  not  entirely  passed  away,  but  the  patient  may, 
after  a few  more  months,  reasonably  entertain  sanguine 
hopes  of  recovery. 

John  Hunter  says,  the  longest  period  of  incubation  is 
seventeen  months. 

Dr.  Dolan  thus  sums  up  : — 

1st.  The  duration  of  the  latent  stage  has  an  indefinite, 
though,  to  a certain  extent,  a regular  course,  for  the 
majority  of  cases  collected,  not  only  by  English,  but  by 
foreign  observers,  prove  that  the  interval  has  generally 
been  from  one  to  three  months. 

2d,  That  age  influences  the  incubatory  period,  it  being 
shorter  in  young  than  in  old  people.  Heming  tells  us 
that  from  an  estimate  of  ages,  from  three  to  twenty,  and 
from  twenty  to  seventy-two,  it  has  been  found  that  for 
the  first  group  there  was  a mean  period  of  forty-four 
days,  and  for  the  second  of  seventy-five  days. 

3d.  Having  such  an  almost  accurate  idea  of  the  aver- 
age period  of  incubation,  the  physician,  while  not  ne- 
glecting all  reasonable  precautions,  can  hold  out  reason- 
able hopes  to  his  patient  of  an  almost  perfect  immunity 
after  three  months,  and  an  increasing  hope  with  every 
month  that  passes,  so  that,  after  a year,  he  may  afford  a 


INCUBATION. 


63 


scientific  certainty  of  the  patient^s  safety.  In  other 
words,  all  reported  cases  of  rabies  occurring  after  a year 
must  be  looked  upon  with  suspicion,  and  should  the 
symptoms  be  simulative,  other  causes  must  be  assigned, 
as  re-inoculation,  etc. 

Concerning  the  period  of  incubation,  Dr.  Hammond 
w'rites:  ^Hhe  duration  of  this  stage  is  variable.  It  is 
rarely  shorter  than  a month,  and  probably  never  longer 
than  two  years.  Instances  are  on  record,  however,  in 
which  the  disease  has  been  developed  within  ten  days, 
and  others,  about  which,  however,  there  is  much  doubt, 
in  which  the  latent  period  has  reached  to  ten  years  and 
longer.  The  vast  majority  of  cases  occur  within  seven 
months  after  the  reception  of  the  wound.  In  six  cases 
which  have  been  under  my  observation  the  period  of 
incubation  varied  from  about  twenty-five  days  to  four 
months  and  a half.  Dr.  John  Johnston,  however,  in 
Medical  Essays,  1795  to  1805,  refers  to  an  opinion  that 
in  hot  countries  the  disease  has  appeared  four  or  five 
days  after  the  bite,  and,  in  the  margin  of  the  page  on 
which  the  statement  is  made.  Dr.  Hosack,  to  whom  the 
book  formerly  belonged,  has  written  a note  in  which  he 
states  that  it  ensued  in  a child  in  New  York  five  days 
after  the  bite  was  inflicted. 

From  an  analysis  of  one  thousand  and  fifty  cases,  I 
find  that  the  period  of  incubation  in  four  hundred  and 
ninety-three  cases  was  within  sixty  days,  and  it  seems 
quite  probable  that  Watson  was  correct  in  his  theory 
that  the  virus  is  shut  up  in  a nodule  of  lymph,  there  to 
remain  perdu  until  some  exciting  cause  shall  set  it  free. 

Theories  of  Incubation. — Dr.  Dolan  has  very  excel- 


64 


HYDKOPHOBIA. 


lently  condensed  the  literature  upon  this  division  of 
hydrophobia,  and  from  him  we  learn,  ^^That  the  virus 
being  introduced  into  the  skin,  or  through  any  abraded 
surface,  the  natural  questions  suggest  themselves  : Does 
it  remain  hermetically  sealed  up  for  a time  ? Does  it 
produce  a change  in  the  system  before  the  development 
of  the  symptoms?  Is  it  a slumbering  germ  which  may 
be  roused  into  action  by  various  exciting  causes?  * * 

Faber  imagined  the  contagious  principle  became  en- 
cysted on  its  introduction,  and  that  it  entered  the  blood 
under  the  influence  of  certain  favorable  conditions/^ 

Brown-Sequard  is  of  opinion  that  an  alteration  takes 
place  in  the  part  of  the  body  bitten  by  a rabid  animal 
before  the  characteristic  phenomena  of  rabies  appear ; 
that  the  convulsions  follow  a kind  of  aura,  starting  from 
the  wound  or  cicatrix.  He  therefore  lays  the  locus  in 
quo  in  the  wounded  nerves.  This  theory  is  negatived 
by  the  facts  that  the  nerves  have  been  excised  and  the 
limb  amputated  without  benefit,  after  the  symptoms  have 
appeared,  also  by  the  fact  that  in  the  majority  of  cases 
the  wounded  part  shows  no  evidence  of  alteration. 

Jesse  Foote,*  in  1788,  published  a very  valuable 
pamphlet,  dedicated  to  Pott,  on  the  value  of  excision. 
He  reasoned  from  analogy,  from  the  bite  of  a viper,  and 
from  experiments  made  on  the  guinea  pig,  that  excision 
would  be  useful  before  absorption  had  commenced.  He 
also  drew  his  inferences  from  the  experiments  of  the 
Abbe  Fontana,  who  had  made  6000  experiments  on  the 
effect  of  the  bites  of  vipers. 

* An  Essay  on  the  Bite  of  a Mad  Eog^  by  Jesse  Foote,  Surgeon, 
London,  1788. 


INCUBATIOJ^'. 


65 


Dr.  Anthony  Todd  Thompson,  in  the  Medico-Chir. 
Transactions,  vol.  xiii,  1826,  in  his  comments  upon  a 
case  of  rabies  from  the  bite  of  a cat,  in  1826,  threw  out 
the  hypothesis  that  the  virus  remains  dormant  in  the 
part  where  it  is  deposited  by  the  tooth  of  the  rabid  animal, 
until  a certain  state  of  habit  rendered  the  nerves  in  its 
vicinity  susceptible  of  its  influence,  and  this  being  com- 
municated, a morbid  action  is  begun  in  these  nerves,  and 
extended  to  the  respiratory  nerves,  which  induce  the 
whole  train  of  symptoms  constituting  the  disease. 

In  the  Lancet,  vol.  ii,  p.  809,  1827,  Mysotoxicos  tells 
us  tliat  everything  leads  to  the  belief  that  the  virus, 
which  has  afterward  to  contaminate  the  circulation,  is 
generated  in  the  wounded  part  from  the  germ  first  de- 
posited there  by  the  tooth  of  a dog,  just  as  we  see  takes 
place  in  variola,  vaccinia,  and  syphilis,  the  period  of 
assimilation  being  different  in  all  these.  But  as  soon  as 
absorption  of  this  assimilated  matter  commences,  the 
symptoms  of  the  disease  begin  to  show  themselves.  He 
also  says  that  the  modern  and  well  authenticated  experi- 
ments have  proved  that  when  a poison,  whether  mineral, 
vegetable,  or  animal,  is  applied  to  a wound,  the  animal 
is  not  affected  until  absorption  has  taken  place,  for  if  an 
exhaustive  cupping  glass  be  placed  over  the  poisoned 
part,  but  one  minute  before  the  expiration  of  the  time  at 
which  the  poison  is  known  invariably  to  produce  its 
effects,  the  animal  exhibits  no  symptoms  whatever. 

The  experimeiits  of  Jesse  Foote  prove  that  a guinea 
pig  might  be  bitten  by  a viper,  and  five  minutes  allowed 
to  elapse  before  amputation  of  the  part  bitten  was  ef- 
fected, when  the  animal  survived.  Mysotoxicos  also 


66 


HYDEOPHOBIA. 


suggested^  under  the  presumptive  impression  that  in 
rabies,  as  well  as  in  other  varieties  of  poisoning,  the 
transport  of  the  deleterious  matter  from  the  wound  into 
the  system  and  the  appearance  of  the  symptoms  followed, 
as  cause  and  effect,  some  special  precautions  might  be 
taken,  even  when  the  symptoms  were  pronounced. 

When  the  cicatrix  feels  at  all  tender,  he  advises : — 

1.  The  immediate  application  of  a cupping  glass  for 
an  hour. 

2.  The  dissection  out  of  the  bitten  part. 

3.  The  reapplication  of  the  cupping  glass  for  an 
hour. 

Whoever  this  writer  may  be,  who,  fifty  years  ago 
adopted  this  pseudonym,  and  whose  individuality  is  just 
as  much  lost  as  that  of  Junius’,  his  views  are  rational; 
and  though  we  cannot  endorse  them  in  full,  yet  they 
present  as  satisfactory  an  hypothesis  as  we  can  expect, 
on  part  of  the  phenomena.  They  somewhat  resemble 
the  views  of  Todd  Thompson,  which  have  been  revived 
by  some  modern  writers,  as  Sir  Thomas  Watson.  The 
wound  in  the  majority  of  cases  does  not  assume  any 
inflammatory  action,  nor  can  we,  by  the  naked  eye,  dis- 
cover any  alteration  in  the  appearance  at  the  time  of  the 
development  of  rabies.  The  action  of  the  virus  seems 
most  to  resemble  that  of  syphilis,  in  which  we  have  a 
period  of  latent  action,  a period  of  absorption  by  the  lym- 
phatics, and  a subsequent  incubatory  period  of  syphiliza- 
tion.  Further  research  is  necessary,  and  experiments 
with  the  virus,  as  dissecting  or  excising  the  bitten  part, 
and  introducing  it  into  some  animals,  and  then  watching 
its  effects  day  by  day. 


INCUBATION. 


67 


Now  that  hackrice  play  such  an  important  part  in  dis- 
ease, we  shall  expect  some  results  in  this  direction,  and 
a further  explanation  of  the  remaining  part  of  the  phe- 
nomena. 

Virchow,  we  know,  is  of  opinion  that  the  contagium 
of  rabies  has  an  action  similar  to  that  of  ferments. 
This  view  is  a return,  to  a certain  extent,  to  an  old 
theory.  Etmullerus,  in  1683,  said  : The  cause  of  this 
disease  consists  in  a certain  peculiar  ferment,  which 
affects  first  the  spirits  and  then  the  blood.  This  ferment 
is  carried  along  with  the  saliva  into  the  wound.’^ 
That  the  new  elements  introduced  at  the  point  of  inoc- 
ulation are  being  continually  introduced  into  the  blood, 
by  means  of  which  they  act  on  the  nervous  system  ; and 
that  rabies  only  appears  when  these  elements  have  ac- 
cumulated in  an  excessive  quantity. 

As  Fleming  says,  there  may  be  a double  zymosis,  first 
in  the  part,  and  afterwards  in  the  system,  the  result  of 
which  is  either  to  multiply  the  poison  or  to  increase  its 
virulence.  There  are  many  other  ingenious  specula- 
tions, as,  for  instance,  whether  the  virus  is  present  in 
the  secretion  of  the  generative  organ.  For  man,  we  may 
answer  by  the  following  statements  : — 

Chabert  relates  that  a female,  the  wife  of  the  execu- 
tioner, contracted  the  disease.  She  had  cohabited  with 
her  husband  up  to  the  evening  of  his  being  attacked 
with  rabies,  due  to  his  having  been  bitten  by  a rabid 
dog. 

Hoffman  relates  a similar  case;  but  Baudot  mentions 
the  case  of  a young  woman  who  had  cohabited  with  a 
soldier  for  a month,  from  the  day  when  he  had  been 


68 


HYDROPHOBIA. 


bitten  by  a mad  dog,  until  rabies  manifested  itself,  with- 
out becoming  afflicted. 

Bonteille,  Boissiere,  and  Rivollier  mention  cases  in 
which  sexual  intercourse  took  place  Avithin  only  six  hours 
of  the  appearance  of  rabies,  without  transmission. 

The  most  interesting  question*  in  connection  with 
this  subject  is  in  reference  to  the  communicability  of  the 
affection  by  the  human  species.  Coelius  Aurelianns 
relates  an  instance  of  a seamstress  who  became  infected 
by  ripping  with  her  teeth  the  cloak  of  a hydrophobic 
patient.  Palmarius  states  that  a peasant  having  the 
disease  communicated  it  to  some  of  his  children  by  kiss- 
ing them.  Tardieu  relates  a case  of  transmission  from  a 
shepherd  to  a sheep.  Eckel  produced  rabies  in  a dog 
by  inoculation  from  a locksmith  who  had  hydrophobia. 
Two  French  physicians,  Enaux  and  Chaussier,  mention 
cases  wliere  persons  have  become  infected  by  wiping  their 
lips  with  napkins  previously  used  by  hydrophobic  pa- 
tients. In  1830,  Mr.  Earl,  a prominent  London  sur- 
geon, while  administering  medicine  to  a woman  who  was 
suffering  from  the  disease,  chanced  to  be  bitten  by  her, 
and  at  once  proceeded  to  cauterize  the  part.  On  being 
taunted  with  unnecessary  timidity,  he  immediately  inocu- 
lated a number  of  rabbits  with  the  woman’s  saliva, 
and  produced  in  several  of  them  hydrophobic  symptoms 
and  death,  while  a similar  result  did  not  follow  inocu- 
lation with  the  normal  secretion.  The  celebrated  ex- 
periments made  by  Magendie  and  Breschet  at  the  Hotel 
Dieu,  in  Paris,  in  1813,  were  no  less  remarkable.  They 
inoculated  two  healthy  dogs  with  saliva  from  a patient 
*Dr.  Russell,  Op.  cit. 


INFLUENCE  OF  SEX^  AGE^  AND  CLIMATE.  69 

named  Surlu^  who  iied  of  hydrophobia  a few  hours 
afterward.  One  of  the  animals  escaped ; the  other,  care- 
fully secluded,  became  rabid  in  six  weeks,  and  having 
been  made  to  bite  several  dogs  they  soon  went  mad  and 
infected  others  still.  Hertwig  also  is  said  to  have  suc- 
cessfully transplanted  the  virus  from  a man  to  a dog ; 
and  Busnont,  Berndt,  Loffler,  and  Renault,  of  Alfort, 
likewise  have  demonstrated  that  the  disease  is  capable 
of  transmission  from  mankind  to  the  canine  race.^^ 

SEX,  AGE,  AND  SEASON  OF  THE  YEAE. 

The  male  sex  appears  to  be  the  most  exposed  to  hy- 
drophobia. In  England,  from  1847  to  1858*,  133  deaths 
took  place  from  rabies,  viz  : 103  males  and  30  females. 
In  France, from  1850  to  1859,  males  175;  females  64.  In 
Bouley^s  analysis  of  320  persons  bitten,  206  belonged  to 
the  male,  and  81  to  the  female  sex ; the  sex  not  being  indi- 
cated in  the  remaining  33. 

In  the  United  States,  out  of  eighty  well  authenticated 
cases,  from  1849  to  1879,  seventy  were  males  and  ten 
were  females. 

Age. — According  to  Dr.  Dolan,  in  England,  in  1866, 
the  number  of  deaths  being  thirty-six,  the  ages  were  as 
follows : — 


Years. 

Deaths. 

Years. 

Deaths. 

Under  5, 

6; 

From  25  to  30, 

5; 

From  5 to  10, 

9; 

u 

30  “ 40, 

2; 

“ 10  “ 15, 

2; 

a 

50  “ 60, 

2;. 

“ 15  “ 20, 

4; 

a 

O 

OO 

2. 

“ 20  “ 25, 

4; 

Fleming,  Op.  cit. 


70 


HYDROPHOBIA. 


Boudin  gives  the  following  ages  of  136  persons  who 
died  from  rabies  .in  France: — 

Years.  Deaths. 

Years.  Deaths. 

Under  5,  7 ; 

From  30  to  60,  54; 

From  5 to  15,  30; 

O 

00 

“ 15  “ 20,  15; 

“ 20  “ 30,  12; 

70  upward*  6. 

Bouley  gives  the  ages  in  124  cases^  from  which  we 
find  that  the  largest  number  of  accidents,  97  out  of  174, 
occurred  between  the  ages  5 to  15.  The  following  is  his 
summary  of  facts  collected  from  the  report  made  to  the 
Consulting  Committee  of  Public  Hygiene  : — 

1st.  In  forty-nine  departments  wherein  rabies  are  re- 
ported by  one  hundred  and  eight  communications,  three 
hundred  and  twenty  persons  have  been  bitten  by  rabid 
animals.  This  figure  is  enormous,  but  must  be  regarded, 
nevertheless,  as  far  below  the  truth,  for  there  are  de- 
partments where  the  disease  is  common,  and  from  which 
no  reports  were  obtained. 

^^2d.  Out  of  three  hundred  and  twenty  persons  bitten, 
the  bites  caused  hydrophobia  in  one  hundred  and  twenty- 
nine  cases,  or  a mortality  of  about  forty  per  cent. 

^^3d.  Out  of  three  hundred  and  twenty  persons  bitten, 
the  wounds  were  not  followed  by  the  disease  in  one 
hundred  and  twenty-three  known  and  specified  cases. 

The  established  rate  of  innocuousness  would,  there- 
fore, be  about  thirty-eight  per  cent.  But  we  must  con- 
sider that  sixty-eight  cases  remain,  the  termination  of 
which  have  not  been  reported ; a fact  which  admits  the 
supposition  that  for  a majority  of  the  bitten  people, 
counting  in  these  sixty-eight  cases,  the  wounds  had  no 


INFLUENCE  OF  SEX,  AGE,  AND  CLIMATE.  71 

fatal  results,  for  the  termination  by  death  from  a wound 
by  a rabid  animal  would  certainly  not  escape  public 
notoriety.  We  may  conclude,  therefore,  that  the  major- 
ity of  the  cases  reported  in  the  investigation,  of  which 
the  death  is  not  mentioned,  the  persons  bitten  have  con- 
tinued perfectly  free  from  the  disease. 

^^4th.  Among  the  three  hundred  and  twenty  bitten 
persons,  two  hundred  and  six  were  males,  eighty-one  fe- 
males, and  in  thirty-three  cases  the  sex  is  not  mentioned. 
This  result  is  perfectly  in  accordance  with  those  obtained 
from  previous  statistics.  The  number  of  females  is  al- 
ways much  lower  than  that  of  males,  which  can  be  ex- 
plained only  by  the  fact  that  they  are  less  exposed,  in 
consequence  of  their  habits  and  of  their  household  work, 
to  be  met  by  mad  dogs ; and  when  exposed  to  their 
rage,  the  character  of  their  clothing  offers  a means  of 
protection,  for  the  animal  satisfies  his  fury  by  biting 
anything  that  falls  in  his  way. 

‘^5th.  Fatal  results  have  not  been  equal  in  both  sexes. 
Out  of  two  hundred  and  six  male  cases,  one  hundred,  or 
a little  less  than  half,  died ; while  out  of  eighty-one  fe- 
male cases,  twenty -nine,  or  a little  over  one-third,  proved 
fatal.  This  is  forty-eight  per  cent,  in  the  former,  and 
thirty-six  per  cent,  in  the  latter  case.  These  figures, 
however,  carry  with  them  nothing  conclusive. 

6th.  The  age  is  indicated  in  two  hundred  and  seventy- 
four  cases,  the  subdivision  of  which  into  a decimal  series, 
shows  these  interesting  facts : The  greatest  proportion- 
ate number  of  bites  (namely,  ninety-seven  out  of  two 
hundred  and  seventy-four)  correspond  to  the  series  of 
five  to  fifteen  years ; that  is,  the  age  of  imprudence, 


72 


HYDKOPHOBIA. 


weakness^  play  and  teasing.  Mad  dogs  would  generally 
avoid  and  spare  children  with  whom  they  are  familiar, 
were  they  not  excited  by  the  continual  irritation  which 
children  inflict  upon  them.  This  fact  is  also  explained 
because  dogs  will  meet  more  children  than  other  persons 
in  the  streets  and  lanes  where  they  collect  to  play. 

‘‘  7th.  Another  interesting  fact  is  this,  that  the  mortal- 
ity is  much  less  in  the  series  where  the  number  of  bitten 
cases  is  greatest.  The  ninety-seven  cases  reported  in 
children  from  five  to  fifteen  years,  proved  fatal  in  only 
twenty-six  cases,  while  in  the  other  series  the  mortality 
has  been  twelve  out  of  twenty-five,  twenty-one  out  of 
thirty-four,  and  seventeen  out  of  twenty-eight.  Hence 
the  conclusion  that,  if  children  are  more  exposed,  they 
probably  are  less  predisposed  to  contract  hydrophobia, 
protected  as  they  probably  are  by  their  natural  freedom 
from  anxiety,  and,  consequently,  by  perfect  mental 
quietude. 

8th.  The  bites  have  been  inflicted  by  dogs,  principal- 
ly, and  chiefly  by  male  dogs.  Out  of  the  three  hundred 
and  twenty  persons  bitten,  two  hundred  and  eighty-four 
were  wounded  by  male  dogs,  twenty-six  by  female  dogs, 
five  by  cats,  and  five  by  wolves.  No  bite  of  an  herbiv- 
orous animal  is  reported  in  these  documents. 

9th.  With  reference  to  the  distribution  of  the  cases 
throughout  the  year,  the  following  facts  are  obtained. 
During  the  three  spring  months,  March,  April,  and 
May,  eighty-nine  cases  occurred;  during  the  summer 
months,  June,  July,  and  August,  seventy-four  cases; 
during  the  autumn  months,  September,  October,  and 
November,  sixty-four  cases;  and  during  the  winter 


INFLUENCE  OF  SEX,  AGE,  AND  CLIMATE.  73 

months,  December,  January,  and  February,  seventy- 
five  cases.  This  leads  us  to  conclude,  then,  1.  That 
there  is  no  o^reat  difference  between  the  seasons:  2.  That 
the  dantrer  from  mad  do^s  in  the  winter  season  is  about 
the  same  as  in  the  heat  of  summer ; 3.  That  in  the 
spring  cases  are  most  frequent,  and  in  the  autumn  least 
frequent;  4.  That  the  public  opinion  which  regards 
winter  as  free  from  the  curse  of  hydrophobia,  and  incul- 
pates summer  as  causing  the  disease  more  than  any  other 
season,  has  no  foundation  in  fact. 

This  brings  us  to  a conclusion  of  great  importance, 
namely,  that,  so  far  as  sanitary  measures  and  the  protec- 
tion of  the  people  is  concerned,  at  all  times  and  in  all 
seasons  we  should  be  equally  on  our  guard,  and  take 
efficient  measures  of  protection  against  dogs.  We  must, 
however,  observe  that  although  the  actual  statistics  fur- 
nish figures  indicating  an  almost  parallel  number  of 
cases  for  the  seasons  of  extreme  heat  and  extreme  cold, 
it  is  due  to  the  greater  care  in  carrying  out  sanitary 
measures  in  summer  than  in  winter. 

^^lOth.  Concerning  the  duration  of  the  incubative  stage, 
the  statistics  give  results  of  great  importance,  whether 
viewed  by  themselves  or  in  connection  with  previous 
statistics.  Out  of  one  hundred  and  twenty-nine  cases 
followed  by  fatal  results,  the  duration  of  incubation  was 
observed  one  hundred  and  six  times;  and  it  is  shown 
that  the  manifestations  have  been  most  numerous  during 
the  first  sixty  days,  viz.,  seventy-three  cases  out  of  the 
one  hundred  and  six.  The  other  thirty-three  cases  are 
irregularly  distributed  as  far  as  the  two  hundred  and 

fortieth  day,  a jieriod  of  eight  months;  but  they  become 
6 


74 


HYDROPHOBIA. 


gradually  less  and  less  numerous^  so  that  after  the  hun- 
dredth day  the  cases  are  counted  only  one  or  two  per 
mouthy  and  in  the  eighth  month  there  was  but  a single 
case.  Hence  the  conclusion  is,  that  after  a rabid  bite 
the  probabilities  of  escape  increase  considerably  when 
two  months  have  passed  and  no  rabid  manifestations 
have  shown  themselves,  and  that  after  the  ninetieth  day 
entire  immunity  is  almost  certain. 

No  doubt  that  after  this  period  the  danger  is  not  en- 
tirely over,  and  that  even  then  bitten  persons  are  not 
entirely  exempted ; but  the  prospects  are  more  favor- 
able, and  great  hope  may  be  entertained  for  their  recov- 
ery. It  has  been  established  from  previous  statistics 
that  the  duration  of  the  incubative  stage  is  much  short- 
er, as  the  subjects  afflicted  with  bites  were  more  ad- 
vanced in  age.  The  results  furnished  lately  confirm  this 
conclusion.  In  comparing  the  periods  of  incubation 
between  the  ages  of  three  and  twenty,  we  find  the  aver- 
age period  is  forty-four  days;  and  comparing  the  same 
between  the  ages  of  twenty  and  seventy-two,  we  find 
the  average  period  of  incubation  is  seventy-five  days ; a 
marked  difference,  which  is  of  great  importance  in 
prognosticating  the  possible  consequences  following  rabid 
bites  in  the  early  period  of  life. 

^^llth.  The  duration  of  the  disease  was  recorded  in 
ninety  cases,  which  show  that  death  took  place  seventy- 
four  times  within  the  first  four  days,  the  largest  number 
of  deaths  corresponding  to  the  second  or  third  day. 
Life  was  only  prolonged  beyond  the  fourth  day  in  six- 
teen cases.  Again,  the  statistics  show  that  death  has 
been  the  invariable  termination  of  cases  of  hydrophobia, 


INFLUENCE  OF  SEX,  AGE,  AND  CLIMATE.  75 

and  that  the  unfortunate  victims  have  undergone  the 
most  friglitful  mental  and  physical  sufferings,  which  ex- 
plains and  justifies  the  terror  of  hydrophobia,  which 
people  of  all  classes  entertain. 

^‘12th.  The  documents  of  the  investigation  furnish  in- 
dications full  of  interest  in  regard  to  the  more  or  less 
innocuousness  of  bites,  according  to  the  different  parts  of 
the  body  upon  which  they  were  inflicted.  If  we  com- 
pare the  fatal  with  the  harmless  bites  made  upon  the 
same  region,  we  find  that  out  of  thirty-two  cases  where 
the  face  was  bitten,  twenty-nine  proved  fatal,  which 
gives  for  these  wounds  a mortality  of  ninety  per  cent. 
Out  of  the  seventy-three  cases  in  which  the  wounds  were 
upon  the  hands,  they  have  been  fatal  in  only  forty-six 
cases,  harmless  in  twenty-seven,  giving  an  average  mor- 
tality of  sixty-three  per  cent.  In  comparing  the  wounds 
of  the  arms  and  legs  with  those  of  the  face  and  hands, 
the  ratios  are  inverted ; twenty-eight  wounds  upon  the 
arms  were  followed  by  only  eight  fatal  terminations,  and 
twenty-four  bites  upon  the  lower  limbs  gave  only  seven 
fatal  cases — seventeen  remained  harmless — showing  a 
mortality  of  twenty-eight  and  twenty-nine  per  cent.,  and 
an  innocuousness  of  seventy  to  seventy-one  per  cent. 
And,  lastly,  the  ratio  of  mortality  for  wounds  upon  the 
body  is  shown  as  follows : out  of  nineteen  bitten,  twelve 
cases  were  fatal,  and  seven  bites  proved  harmless. 

These  facts,  which  are  confirmatory  of  those  afforded 
by  other  statistics,  demonstrate  also,  that  rabid  wounds 
upon  uncovered  or  unprotected  parts,  such  as  the  face 
and  hands,  are  much  more  readily  contagious  than  those 
of  the  arms  and  legs,  which  the  teeth  of  the  animal  can- 


76 


HYDBOPHOBIA. 


not  reach  without  passing  through  a portion  of  the  cloth- 
ing, which  wipes  off  the  virulent  moisture  from  the  teeth. 
It  is  true,  the  consequences  of  bites  upon  the  body  seem 
to  conflict  with  this  statement.  But  we  must  remember 
that  generally  these  wounds  are  more  severe;  that 
among  them  some  are  upon  uncovered  parts,  such  as  the 
neck  and  chest ; and  that  when  a man  is  bitten  by  a 
rabid  animal,  and  bitten  upon  the  body,  he  is  also  bitten 
upon  his  hands,  which  are  his  natural  means  of  de/ence. 

^^13th.  The  information  obtained  from  these  statistics 
is  of  great  interest,  concerning  the  means  by  which  it  is 
possible  to  prevent  the  effects  of  rabid  inoculation.  If 
we  compare  rabid  wounds  that  have  been  cauterized 
with  those  which  have  not  been^  we  find  a notable  dif- 
ference between  them.  In  fact,  out  of  one  hundred  and 
thirty- four  cauterized  wounds,  ninety-two  resulted  harm- 
lessly, and  forty-two  fatally.  That  is  equal  to  sixty- 
eight  per  cent,  in  the  former,  and  thirty-one  per  cent,  in 
the  latter  case. 

In  non-cauterized  wounds  the  result  is  the  reverse, 
and  more  decided.  Out  of  sixty-six  wounds,  the  mor- 
tality is  represented  by  fifty-six,  or  eighty-four  per  cent.; 
and  harmless  results  by  ten,  or  only  fifteen  per  cent. 
Now,  we  must  observe  in  relation  to  cauterized  wounds, 
that  it  has  been  impossible,  for  lack  of  sufficient  data,,  to 
make  a distinction  between  them  according  to  the  degree 
of  cauterization  and  the  time  when  it  took  place,  two 
conditions  upon  which  depend  the  positive  efficacy  or 
complete  uselessness  of  this  means  of  prevention.  Had 
these  data  been  given,  it  is  not  too  much  to  say  that  the 
proportion  of  properly  cauterized  wounds  which  l*e- 


INFLUENCE  OF  SEX^  AGE,  AND  CLIMATE.  V / 

mained  without  fatal  results  would  have  been  consider- 
ably higher;  for  the  destruction  by  fire,  of  flesh  smeared, 
and  even  impregnated,  with  virulent  saliva,  prevents  the 
occurrence  of  rabies,  we  may  say  certainly,  wliere  it  is 
done  in  time;  that  is,  before  the  fluid  deposited  in  the 
wound  is  absorbed.^^ 

Season  of  the  Year, — The  following  tables  are  taken 
from  Dr.  Russell’s  report  on  hydrophobia  : — 

So  long  ago  as  1780,  Andry  observed  that  January, 
the  coldest,  and  August,  the  hottest  months,  furnished 
the  least  number  of  cases  of  rabies  which  he  was 
able  to  collect;  and  at  a later  period,  M.  Troll iet, 
after  laborious  investigation,  asserted  that  in  France  the 
disease  was  most  frequent  among  dogs  in  May  and  Sep- 
tember, and  among  wolves  in  March  and  April;  and 
that  the  fewest  cases  among  dogs  occurred,  as  Andry  had 
stated,  in  the  months  of  extreme  temperature — January 
and  August.  There  has  already  been  noticed  an  out- 
break of  rabies  among  the  dogs  of  Vienna  in  1841,  when 
the  largest  number  of  cases  were  observed  in  February 
and  May,  and  the  fewest  in  September,  November,  and 
December.  In  Algeria  the  disease  is  most  prevalent 
among  dogs  in  the  autumn  and  winter.  The  distin- 
guished veterinarian.  Professor  Bouley,  in  a communica- 
tion to  the  French  Academy  of  Sciences,  April  J,  1870, 
gives  the  results  of  an  analysis  of  departmental  reports 
in  France  for  the  six  years,  1863  to  1868,  which  exhibit 
for  the  spring,  89  cases;  summer,  74;  autumn,  64;  and 
winter,  75.  Professor  R511,  of  the  Vienna  Veterinary 
Institute,  has  found  the  disease  more  prevalent  in  mild 
than  in  hot  summers.  Faber,  in  his  Wurternberg  sta- 


78 


HYDROPHOBIA, 


tistics^  shows  rabies  to  be  there  most  frequent  in  March^ 
February,  June,  and  January,  and  least  so  in  Septem- 
ber, October,  and  August. 


Table  of  Cases  of  Canine  Rabies  by  Months  and  Seasons, 


1 January. 

j February. 

March.  j 

j April.  j 

j June.  j 

9 

[ August. 

j September.  | 

j October.  | 

j November.  I 

j December.  | 

Total. 

Bourrel : 

123  109 

115 

123 

112 

120 

100 

114 

122 

105 

94 

102 

1,339 

Vienna  Veterinary  School 

.. 

4 

1 

2 

1] 

4 

9 

10 

2 

33 

Pasta 

6 4 

6 

11 

ie 

15 

18 

8! 

9 

9 

7 

*4 

113 

A^eterinarian 

3 ... 

1 

ll 

1 

6 

3 

1 15 

Blatcliford 

11 ! 10 

13 

*6 

* 12 

*8 

8 

i 5 

12 

*6 

8 

2 

101 

Isew  York  City 

3|  1 

4 

5 

j 6 

1 

1 

2 

1 

3 

3 

2 

A 

Total 

146! 124 

143 

146 

145 

146  129 

134  153 

133 

120 

113 

: 1,632 

Spring. 

Summer. 

Autumn. 

AVinter. 

M’ch,  Apr., 
May. 

June,  July, 
August. 

September, 

October, 

November. 

December, 

January, 

February. 

Total 

Statistics  given  above 

434 

409 

406 

383 

1,632 

313 

Paris 

77 

74 

91 

81 

Dyons 

147 

121 

96 

96 

460 

Toulouse 

16 

2 

11 

4 

33 

lladcliffe 

30 

15 

14 

23 

82 

Total 

704 

621 

608 

i 587 

2,520 

SYMPTOMS,  DIAGNOSIS,  PKOGNOSIS. 


79 


CHAPTER  V. 

SYMPTOMS,  DIAGNOSIS,  PROGNOSIS. 

The  following  excerpt  from  the  New  York  Herald,  of 
April  23(1,  1879,  presents  us  with  an  instance  of  the 
symptoms  of  an  ordinary  case  of  hydrophobia.  It  is 
reported  by  Dr.  P.  J.  Pendergrast : — 

I was  first  called  to  see  Thomas  Kelly,  on  Monday  morning.  I 
found  him  lying  in  bed.  He  is  a young  man  of  fine  physique,  and 
possessed  of  considerable  muscular  power.  I conversed  with  him, 
and  found  him  quite  rational  when  I first  saw  him.  He  told  me 
that  he  had  been  bitten  by  a dog  in  the  right  hand,  some  time  in 
February  last,  and  he  exhibited  a cauterized  scar.  On  last  Satur- 
day he  felt  pains  extending  along  his  right  arm  to  the  shoulder,  and 
a fever  soon  afterward  set  in.  Growing  nervous  and  irritable,  he 
went  to  bed  and  sought  to  obtain  rest.  He  was  unable  to  partake 
of  food  in  a solid  or  liquid  form,  and  had  occasional  spasms. 
When  I was  called  in  on  Monday  about  the  same  symptoms  pre- 
vailed. I suspected  then  the  true  nature  of  the  malady.  He  could 
not  bear  to  hear  even  the  name  of  w^ter  mentioned,  and  the  run- 
ning of  water  from  the  hydrant  caused  him  to  shudder  and  tremble. 
I found  his  pulse  120,  but,  though  he  was  very  feverish  and  excit- 
able, his  tongue  dry  and  lips  parched,  he  knew  me,  and  was  quite 
rational.  After  listening  to  his  narrative  of  the  case,  I sought  to 
disabuse  his  mind  of  any  needless  imagination  he  might  have  on 
the  subject  of  hydrophobia,  of  which  he  then  spoke  coolly  and 
collectedly.  He  said  he  had  not  been  troubled  from  the  bite  till 
Saturday,  nor  did  he  let  his  mind  dwell  on  the  matter.  When  I 
put  the  thermometer  into  his  mouth  to  try  the  temperature  of  his 
tongue  he  snapped  it  savagely,  and  I was  obliged  to  apply  the 
thermometer  elsewhere.  There  was  something  about  the  glass 
that  suggested  water  and  caused  a sudden  spasm.  In  the  evening, 
when  I next  saw  the  patient,  he  was  suffering  from  spasms  and  a 
stifling  and  suffocating  sensation  in  the  throat.  Spasms  were  then 


80 


HYDROPHOBIA. 


occurring  about  every  ten  minutes,  tlie  teeth  were  firmly  set  and 
the  jaws  contracted.  When  I saw  Kelly  this  morning  he  was  de- 
lirious. His  temperature  was  102.8  degrees,  and  his  pulse  was  up 
to  130.  The  spasms  recurred  at  shorter  intervals,  each  one  being 
more  violent  than  the  preceding  one.  They  extended  to  the 
muscles  of  the  chest  and  legs,  and  he  foamed  from  the  mouth. 
The  poor  fellow,  in  his  terrible  sufferings,  frequently  exclaimed, 
“ I’ll  bite’ you.  I’ll  bite  you,  if  you  come  near  me!”  The  least 
draught  or  current  of  air  would  produce  a spasm,  and  even  the 
sudden  raising  of  the  bed-clothes  and  letting  them  fall  again  would 
cause  the  same  difficulty.  After  each  spasm  he  is,  of  course, 
greatly  prostrated.  With  the  exception  of  two  spoonfuls  of  brandy 
and  milk,  which  he  swallowed  on  Monday  with  great  difficulty,  he 
has  not  partaken  of  any  food  since  Saturday. 

Virchow*  has  divided  the  symptoms  into  several  dis- 
tinct stages.  In  the  first  stage  there  are  feelings  of 
malaise^  uneasiness^  restlessness,  loss  of  appetite,  stiffness 
around  the  neck  and  throat,  pyrexia,  nausea,  vomiting, 
headache  and  excitement.  But  these  symptoms  are  not 
always  present,  for  the  patient  often  suddenly  develops 
the  difficulty  of  swallowing  liquids,  so  characteristic  of 
the  disease.  The  local  symptoms  are  sometimes  present, 
sometimes  absent.  There  may  be  irritation  of  the  cica- 
trix in  the  neighborhood  of  the  bite,  accompanied  by 
shooting  pains  of  the  character  of  chronic  rheumatism  j 
this  symptom  being  one  of  the  most  ])ersistent.  The 
cicatrix  may  become  red,  swollen  or  inflamed,  and,  if 
unhealed,  may  assume  an  unhealthy  appearance,  dis- 
charging a thin,  ichorous  fluid.  The  morale  is  changed, 
patients  become  depressed,  lonely,  quieter,  and  listless; 
some  are  anxious  about  the  bite,  others  endeavor  to  dis- 
* Dr.  Dolan.  Op.  cit. 


SYMPTOMS,  DIAGNOSIS,  PEOGNOSIS. 


81 


miss  it  from  their  memory.  Many  are  usually  irritable 
and  ill  tempered. 

As  Poland  remarks,  there  often  ensues  a characteristic 
anxiety,  attended  with  pain  in  the  praecordia,  and  sense 
of  weight  and  pressure  on  the  chest.  There  is  disturbed 
and  broken  sleep,  the  patient  suddenly  starting  up  in 
frightful  dreams;  often  sinking  back  into  mental  de- 
pression, and  becoming  apprehensive  and  gloomy.  The 
generative  organs  are  sometimes  excited,  inducing  pria- 
pism and  seminal  ejections.  There  is  loss  of  appetite, 
no  desire  for  swallowing,  a feeling  of  clamminess,  sigh- 
ing, and  oppression  of  breathing,  with  unusually  deep 
inspirations.  The  voice  is  rough ; there  is  a sense  of 
languor  and  lassitude;  great  weakness  and  heaviness; 
sometimes  slight  convulsive  twitching  about  the  face 
and  extremities;  the  hearths  action  is  strong.  This 
description  is  based  upon  Poland,  Tanner,  Fleming,  and 
some  of  the  older  writers,  besides  the  descriptions  afforded 
by  individual  authors  who  have  had  practical  experience 
of  the  disease.  In  fact,  one  description  is  the  copy  of 
another.  According  to  Fleming,  the  urine,  at  first 
limpid,  becomes  red,  sanguinolent,  and  flows  in  a small 
quantity  after  the  paroxysms.  It  contains  renal  epi- 
thelium and  much  albumen. 

The  researches  of  M.  Gubler  at  the  Beaujon  Hospital, 
France,  show  that  in  hydrophobia  the  urine  is  acid; 
nitric  acid  added  to  it  develops  a thick  coagulum  of  al- 
bumen, and  determines  the  formation  of  a diaphragm  of 
uric  acid,  mucus,  and  an  abundance  of  earthy  phosphates, 
and  carbonates.  Heated  in  a tube,  and  cleared  by  filtra- 
tion of  the  albuminous  precipitate,  the  urine  of  hydro- 


82 


HYDROPHOBIA. 


phobic  patients,  when  submitted  successively  to  the 
action  of  caustic  potassa  and  the  cupra-potassic  fluid,  gives 
reactions  which  indicate  the  presence  of  a notable  quan- 
tity of  sugar.  The  presence  of  this  sugar  would  appear 
to  be  mainly  due  to  the  congestion  of  the  brain  and 
spinal  cord,  as  well  as  the  kidneys,  according  to  some 
authorities. 

Bazin  says  that  if  the  albuminuria  and  glycosuria  were 
noted  at  a stage  of  the  disease  when  asphyxia  had  not 
yet  commenced,  or  during  the  period  of  incubation,  they 
would  be  of  importance  as  symptoms;  they  would 
demonstrate,  in  fact,  that  before  the  outbreak  of  the 
malady  grave  alterations,  due  to  the  passage  into  the 
blood  of  some  virulent  matter,  are  taking  place.  The 
temperature  is  increased  from  the  commencement  of  the 
disease,  and  rises  as  high  as  105°  or  106°  (Fahr.)  in 
the  later  statues.  In  one  of  the  Nottino-ham  cases,  re- 
corded  in  the  British  Medical  Journal  for  December  2d, 
1871,  post-mortem  thermometrical  observations  were 
made  (per  rectum),  which  proved,  beyond  a doubt,  the 
intensity  of  the  chemical  change  taking  place  in  the 
body,  at  least  during  the  last  period  of  the  malady.  The 
temperatures  were  as  follows:  At  11.30  a.m.,  106.2°; 
at  12.45  P.M.,  103.4°  ; at  1.45,  101.2°  ; at  2.45,  98.4° ; 
at  3.45,  91.2°. 

The  second  or  actually  specific  stage  is  that  of  irri- 
tation, dread  of  drink  being  its  chief  character.  It  gen- 
erally follows  after  the  premonitory  stage,  but  in  some 
cases  it  may  become  developed  at  once,  so  rapid  and 
sudden  as  to  take  place  without  any  preliminary  mani- 
festations. It  is  ushered  in  with  stiffness  of  the  muscles 


SYMPTOMS,  DIAGNOSIS,  PROGNOSIS. 


83 


of  the  throat,  jaw,  and  root  of  the  tongue,  pains  in  tlie 
epigastrium  and  diaphragm,  chilliness  and  drowsiness. 
Next,  there  is  hyperjesthesia  of  the  eighth  pair  of  cerebral 
nerves,  as  evinced  by  the  convulsive  spasms  of  the  mus- 
cles of  deglutition,  rendering  every  attempt  at  swallowing 
difficult  and  causing  severe  paroxysms.  Hence  the 
great  dread  of  solids  and  fluids,  and  the  subsequent  dry- 
ness of  the  mouth  and  throat,  with  distressing,  burning 
thirst,  which  cannot  be  quenched ; the  spasms  extend  to 
the  muscles  of  the  larynx,  inducing  hurried  respiration, 
and  a sense  of  suflbcation;  the  voice  is  changed  and 
hoarse;  the  secretion  of  the  mouth  and  fauces,  which 
were  at  first  frothy,  become  now  viscid,  and  can  only  be 
expelled  with  difficulty,  causing  a hawking  and  barking 
noise  in  the  effort;  the  convulsive  spasm  afterward  in- 
volves the  muscles  of  the  general  system,  through  the 
spinal  and  cerebral  nerves,  inducing  convulsions  which 
may  resemble  tetanus  and  epilepsy.  The  thirst  recalls 
the  lines  of  Celsus  (Lib.  v,  cap.  27) : Miser rimum  genus 
morbi ; in  quo  simul  ceger  et  aquce  metu  cruciatur ; quo 
oppressis  in  anguslo  spes  est^ 

There  are  flatulency  and  vomiting  of  a dark-greenish 
bilious  fluid ; the  micturition  is  frequent,  and  in  later 
stages  the  urine  is  passed  involuntarily ; the  senses  are 
rendered  morbidly  acute,  the  surface  of  the  body  irrit- 
able and  readily  acted  upon  by  the  slightest  gust  of  air, 
even  the  feeling  of  the  pulse  inducing  an  accession  of 
the  convulsive  paroxysms ; the  sight  or  sound  of  fluids 
cannot  be  borne,  as  aggravating  the  attacks  ; sometimes 
even  the  smell  of  particular  things  will  do  so.  The 
mind  becomes  in  a frightful  state  of  anxiety  and  alarm; 


84 


HYDEOPHOBIA. 


there  is  a fear  of  even  their  best  friends^  and  of  being 
left  alone;  there  is  no  comfort  or  consolation^  but  inde-^ 
scribable  despair^  and  sometimes  entire  loss  of  control, 
exciting  rage.  Coelius  Aurelianus  noted  this  hyperses- 
thesia,and  cautioned  practitioners  when  bleeding  such  pa- 
tients to  prevent  the  sound  of  the  blood  being  heard  by 
them — ne  sonitu  pereulsi  commoveantur.  Trousseau 
mentions  a case  of  exalted  sensibility  of  the  nerves  of 
scent.  There  is  no  sleep,  and  the  patient  is  often  talka- 
tive and  verbose.  The  mental  disturbance  may  be  very 
slight,  but  on  the  other  hand,  attended  with  temporary 
rabid  impulses  and  delusions,  sometimes  causing  an  in- 
clination to  bite.  The  features  present  a wild,  sparkling 
appearance ; the  brows  contracted,  the  eyes  staring,  the 
angles  of  the  mouth  contracted,  and  an  intensely  haggard 
and  anxious  aspect.  As  the  disease  progresses,  the 
paroxysms  increase  both  in  frequency  and  violence,  and 
are  oftentimes  attended  with  great  cerebral  excitement, 
bordering  upon  wild,  maniacal  fury;  the  duration  of  this 
stage  may  last  from  twenty-four  to  forty-eight  hours ; it 
is  generally  short  and  severe.  In  rare  instances  the 
patient  gives  way  to  wild  fury,  he  roars,  howls,  curses, 
strikes  at  the  persons  near  him,  and  breaks  or  tears  any- 
thing within  his  reach,  after  which  exhaustion  follows, 
from  which  he  is  aroused  by  another  paroxysm.  The 
third  or  paralytic  stage  is  the  decline  and  last  moments 
of  the  disease.  It  is  attended  with  rapid  depression  and 
nervous  exhaustion,  intermission  of  the  paroxysms,  in- 
coherency  and  delirium  ; there  is  great  emaciation ; the 
mouth  remains  open,  and  the  saliva  runs  out,  or  else 
passes  back  into  the  throat,  causing  a gurgling  noise,  and 


SYMPTOMS,  DIAGNOSIS,  PROGNOSIS. 


85 


the  urgent  attempt  to  swallow  or  spit  it  out  induces  a 
choking  sensation  (Poland).  The  vehemence  with  which 
the  patient  spits  out,  in  the  earlier  stages  of  the  case,  is, 
to  a bystander,  one  of  the  most  striking  phenomena, 
though  toward  the  end  the  jaw  appears  sometimes  par- 
tially paralyzed  (Fleming). 

The  pulse  becomes  small,  quick,  and  irregular,  tlie 
skin  bedewed  with  clammy  sweat,  the  eyes  dull  and 
sunken,  and  the  pupils  large,  and  death  takes  place, 
either  from  asphyxia  during  one  of  the  convulsive 
attacks,  or  from  exhaustion.  The  patient,  however, 
may  die  quietly,  sinking  into  a state  of  repose,  with 
abatement  of  all  the  symptoms  ; in  one  case  being  able 
to  eat  and  drink,  and  expiring  immediately  on  suddenly 
waking.  The  duration  of  the  disease  throughout  its 
whole  course  varies  from  seventy-four  hours  to  six  or 
seven  days;  death  generally  occurs  on  the  second,  third, 
or  fourth  day.  It  has  been  fatal  in  sixteen  hours. 

As  has  been  previously  pointed  out,  hydrophobia  may 
or  may  not  be  a symptom  of  the  disease.  This  fact  was 
alluded  to  by  the  earliest  writers,  Eudemus,  Soranus, 
and  Coelius  Aurelianus;  and  Berkenhout,  writing  in 
1783,  says : I am  even  inclined  to  assert  that  the  hy- 
drophobia is  not  generally  a symptom  of  the  disease 
produced  by  the  bite  of  a mad  dog.  It  rarely  happens 
that  the  patient  has  any  aversion  to  water  or  other 
liquid,  until  by  experience  he  finds  an  insuperable  diffi- 
culty in  swallowing.  He  then  dreads  the  approach  of 
water,  having  already  found  that  the  attempts  to  swal- 
low any  liquid  produce  a violent  and  painful  convul- 
sion, so  that  the  symptom  in  question  is  rather  a real 


86 


HYDROPHOBIA. 


difficulty  in  swallowing  liquids  than  any  dread  of  wa- 
ter. As  far  as  my  own  experience  reaches,  I can  with 
great  truth  aver  that  I have  never  yet  met  with  a single 
patient  who  expressed  any  aversion  to  the  sight,  sound, 
or  mention  of  water,  until  he  had  found  by  experience 
that  drinking  gave  him  pain.^^ 

Jesse  Foote,  in  1788,  also  says : Dr.  Mead  hath  re- 
marked, and  Avith  strict  propriety,  in  my  opinion,  that 
the  Avord  does  not  convey  the  true  meaning  of  the  effect 
of  Avater  upon  the  patient,  Avhen  the  frightful  symptom 
is  upon  him,  Avhich  is  not  a dread  of  Avater,  but  despair 
of  gratifying  thirst,  through  the  impossibility  of  SAval- 
lowing  it.’^  The  symptoms  vary  AAuth  the  peculiar 
idiosyncracies  of  the  patient,  and  hence  no  detailed  ac- 
count of  them  may  be  given  which  shall  apply  Avith 
truth  to  every  case.  Referring  again  to  Dr.  Dolan,  Ave 
find  ^^that  there  exist  but  two  periods  in  this  disease ; 
first,  that  of  incubation ; and,  second,  the  period  of  de- 
velopment, including  all  the  phenomena  occurring,  and 
time  elapsing  between  the  first  symptom  and  death.^^ 
The  misnomer — hydrophobia — is  made  apparent  from 
an  analysis  of  over  two  thousand  cases,  in  Avhich  there 
AA^as  not  one  instance  of  dread  of  water/^  The  patients 
ask  for  it,  but  are  prevented  from  SA\MloAving  by  mus- 
cular spasms,  these  being  entirely  due  to  an  exalted  reflex 
excitability  acting  upon  a diseased  mental  condition  in 
Avhich  consciousness  is  retained,  but  the  Avill  so  degene- 
rate as  to  be  unable  to  control  the  external  manifestation 
of  the  appetite  in  such  Avise  as  desire  commands.  Here- 
in lies  a difference  betAveen  the  rabies  of  loAver  animals 
and  the  hydrophobia  of  man.  The  former  drink  Avith 


SYMPTOMS^  DIAGNOSIS^  PROGNOSIS. 


87 


avidity.  San vages  writes : Constat  repetita  apiid  Gallos 
provinciales  experientia,  canes  luposque  rabidos  bibisse, 
manducasse^  flumen  transisse,  nt  olim  Marologii  et  bis 
Forolivii  observatum^  adeoque  nec  cibuni  nec  potum 
aversari.^^ 

Among  many  valuable  papers  sent  me  by  the  United 
States  Consul-General^  at  Berlin^  for  whose  courtesy  I 
am  under  great  obligations^  the  following  will  be  read 
with  interest.  It  is  translated  from  the  Mittheilu'ngen 
aus  der  thierdrtztlichen  Praxis,  1867 : — 

RABIES  IN  THE  DOG,  AND  HYDROPHOBIA  IN  WOMAN. 

BY  BLOCK, 

Veterinary  Surgeon  in  New  Brandenburg. 

On  the  18th  of  July,  1866,  the  wife  of  a shoemaker,  Pr.,  living 
here,  brought  her  pet  dog  to  me,  with  the  following  history  : The 
dog  is  sick,  scrapes  himself,  tears  his  hair  out  with  his  teeth,  and,  on 
account  of  this  behavior,  I believe  him  to  be  mad.”  These  symp- 
toms I found  to  be  true,  and  also  observed  reddish  pustules  scat- 
tered over  his  body  ; they  were  red  spots  of  a small  size,  wdiich 
caused  much  painful  itching,  as  the  dog  often  bit  himself  quite  sud- 
denly, and  with  seeming  satisfaction  and  relief.  At  such  times  his 
hair  flew  about  in  little  bunches.  The  warmth  of  his  skin  increased. 
His  consciousness  was  not  at  once  interfered  with,  as  he  would  get 
a stone  that  had  been  thrown  away,  with  accuracy,  and  would 
punctually  obey,  the  calls  of  his  mistress  I declared  this  disease 
to  be  of  a typhoid  nature,  and  prescribed  glauber  salts  with  extract 
of  gentian  and  henbane,  and  externally  a medicament  for  drying 
the  skin.  The  next  morning  the  woman  said  that  the  dog  had 
been  very  turbulent  during  the  night,  that  he  coughed,  and  that 
slime  appeared  on  his  mouth,  that  he  had  red  eyes,  etc.  At  my 
call  I found,  also,  an  unsteady  “eye-look.”  His  voice  was  peculiar. 
I heard  it  after  the  dog  had  been  carried  into  the  room  in  the  arms 
of  its  mistress.  He  then  ran  into  the  bedroom,  jumped  upon  the 
bed,  and  crawled  under  the  covers,  where  he  howled  in  the  same 
voice  as  I have  heard  in  mad  dogs.  This  barking  is  as  though  the 


88 


HYDROPHOBIA. 


dog  was  in  a half  unconscious  state.  I ordered  the  dog  to  be  tied, 
after  which  I asked  the  veterinary  surgeons,  C.  and  Z.,  to  look  at 
the  dog they  were  not  at  home  ; and  a like  request  to  the  head 
physician  was  answered  with  the  advice  to  use  a muzzle  or  to  tie 
the  dog.  Finally,  I went  to  Dr.  W.,  who  came  with  me  to  see  the 
dog,  who,  as  their  family  physician,  told  the  proprietress  to  observe 
my  orders.  Meantime,  the  veterinary  surgeon,  Z.,  had  been  there, 
and  had  quieted  the  family  by  assuring  them  that  the  dog  was  not 
mad,  and  had  ordered  castor  oil,  which  the  dog  had  taken.  Upon 
my  return  I was  received  coldly,  and  was  told  that  my  medicine 
had  increased  the  illness.  The  next  day  the  dog  died.  I was  not 
informed  of  the  fact,  but  subsequently  I was  told  that  the  dog 
had  swallowed  a bone,  which  pierced  his  bowels,  and  he  died  in 
consequence.  The  dog  had  been  ill  a week,  during  which  time 
he  had  paroxysms  of  periodical  restlessness,  slime  in  the  mouth, 
red  eyes,  tearing  out  of  his  hair  and  vomiting,  and  at  intervals  he 
was  free  from  all  trouble. 

On  the  10th  of  August  the  niece  of  Mrs.  Pr.,  a young  lady,  twenty- 
four  years  old,  died  of  hydrophobia.  According  to  the  report  of 
Dr.  W.,  she  had  given  the  dog  medicine,  and,  in  addition,  had  inter- 
ested herself  very  much  for  him,  he  being  her  pet  dog,  and,  in  con- 
sequence, was  undoubtedly  infected  by  him. 

The  few  symptoms  observed  gain  strength  and  importance  when 
I add  that  I have  seen  several  cases  of  typhoid  inflammation  in 
dogs  this  year,  which  I have  cured;  that  it  is  epizootic  among 
them,  and  that  this  case  was  such  a one,  grown  into  rabies. 

This  is  confirmatory  of  the  experience  of  Dr.  Jurnitschek,  who 
writes  in  his  pamphlet,  Hundefrage^  1864,  page  37 : “Lately  the 
resemblance  of  these  fits  (hydrophobia)  to  those  of  typhoid  fever 
has  been  more  and  more  marked,  so  much  so  that  some  would 
make  the  disease  identical.  A comparison  might  be  made  with  the 
^influenza’  of  horses,  which,  if  it  assumes  a typhoidal  type,  easily 
merges  into  glanders,  as  was  the  case  with  the  horses  of  the. Princess 
of  Neiistrelitz,  in  1840-43,  or  with  the  plague  in  England,  Belgium, 
etc.,  which  is  considered  by  many  to  be  a lung  disease  of  a high 
grade,  or  with  the  pig  disease  in  Wulkenzin,  Neuendorf  and  Wei- 
ten,  which  turned  into  a worse  form — hypochondriasis — when,  by 
breathing  the  foul  air,  I myself  caught  the  disease.  I consider 
hydiophobia  a disease  of  the  blood,  and  not  one  of  the  nerves; 


SYMPTOMS,  DIAGNOSIS,  PROGNOSIS. 


89 


otherwise,  how  explain  the  pustules,  scratching,  etc.,  except  upon 
a theory  of  congestion  tending  especially  to  the  mucous  membrane, 
together  with  the  slime  of  the  mouth,  paroxysms,  and  the  pro- 
duction of  the  contagion.”  * * * * -st  * 

Diagnosis. — The  symptoms  are  so  characteristic  that 
they  should  not  be  confounded  with  any  other  disease’^ 
(Dr.  Dolan).  From  tetanus,  Drs.  Holland  and  Shink- 
win  point  out  the  following  differences  : — 

1.  Tetanus  results  from  injuries  of  the  most  varied 
character. 

2.  The  effects  follow  in  a very  short  space  of  time;  a 
week  seldom,  if  ever,  elapsing  between  the  injury  and 
the  development  of  the  symptoms;  while  the  shortest 
interval  between  the  bite  and  the  first  symptoms  of 
rabies  was  12  days,  the  longest  334  days,  and  the  aver- 
age 61  days  18  hours  in  the  120  cases  collected  by  Dr, 
Holland. 

3.  That  anxiety,  horror,  dyspnoea,  or  convulsions  at 
the  sight  of  fluids,  form  no  part  of  the  symptoms 
included  under  the  term  tetanus. 

4.  That  in  tetanus  some  of  the  muscles  are  often  in  a 
state  of  rigidity,  and  the  convulsions  occur  at  much 
shorter  intervals  than  in  cases  of  rabies. 

5.  That  delirium  is  a very  rare  symptom  in  tetanus, 
and  a frequent  one  in  rabies,  occurring  80  times  in  120 
cases. 

6.  That  in  tetanus  the  secretion  of  saliva  is  seldom 
increased. 

7.  That  in  tetanus  the  muscles  of  the  lower  jaw  are 
frequently  in  a state  of  continued  tension. 

Opisthotonos,  or  emprosthotonos,  often  terminates 
the  case. 

7 


90 


HYDROPHOBIA. 


9.  As  Fleming  remarks,  physiologically,  while  tetanus 
is  a disease  of  the  true  spinal  system  of  nerves,  rabies 
involves  the  brain  also,  as  evinced  by  the  disorder  of 
intellectual  function,  and  special  sense,  even  early  in  the 
disease. 

From  oesophagitis  Holland  points  out  these  essential 
differences : — 


IN  (ESOPHAGITIS. 

1.  Pain  in  the  pharynx,  throat, 
or  along  the  spine,  occurs  as  the 
earliest  and  invariable  symptom. 


2.  The  attempt  at  swallowing 
solid  food  causes  intense  pain, 
and  in  aggravated  cases  swallow- 
ing of  even  fluids  is  accompanied 
by  pain,  or  may  be  totally  im- 
possible. 

3.  Horror  of  fluids  reported  to 
have  occurred  in  one  case. 

4.  The  amount  of  difficulty  in 
swallowing  is  in  direct  propor- 
tion to  the  extent  and  intensity 
of  the  pathological  appearances 
found  in  the  oesophagus. 

6.  Saliva  abundantly  secreted, 
expectoration  difficult,  and  the 
time  of  the  occurrence  of  these 
phenomena  is  not  fixed. 

6.  Urgent  thirst  in  perhaps 
all  cases. 

7.  Average  duration  of  the 
disease  seven  days. 

8.  Generally  terminating  in 
recovery. 

9 Death  caused  by  oedema  of 
the  glottis,  gangrene,  or  rupture 
of  tlie  oesophagus. 


IN  RABIES. 

1.  Pain  in  the  pharynx,  throat, 
and  along  the  spine,  occurred 
in  42  out  of  120  cases,  or  about 
once  in  every  three  cases,  and 
not  as  the  earliest  symptom. 

2.  The  attempts  to  swallow  flu- 
ids. though  not  generally  accom- 
panied by  intense  pain,  causes 
dyspnoea,  convulsions,  etc  , while 
solids  can  be  in  most  cases  taken 
with  comparative  facility. 

3.  Horror  of  fluids  the  most 
prominent  symptom  in  119  out 
of  120  cases. 

4.  No  direct  relation  exists 
between  the  pathological  state  of 
the  oesophagus  shown  after  death 
and  the  intensity  of  the  dys- 
phagia. 

5.  Saliva  secreted  in  great 
quantity,  often  flowing  sponta- 
neously from  the  mouth,  and 
these  symptoms  often  occurring 
among  the  last  phenomena. 

6.  'I'hirst  was  urgent  in  about 
one-third  of  the  cases. 

7.  Average  duration  of  the 
disease  seven  days. 

8.  Invariably  terminating  fa- 
tally. 

9.  Death  most  probably  re- 
sulting from  asphyxia,  coma,  or 
relapse. 


Fleming,  page  265,  op.  cit.,  says : Indeed,  it  is  not 


SYMPTOMS;  DIAGNOSIS;  PROGNOSIS. 


91 


possible  to  mistake  hydrophobia  for  any  other  malady, 
or  to  doubt  its  existence  when  it  is  present;  for  if,  dur- 
ing the  stage  of  incubation,  doubts  and  fears  may  exist, 
all  uncertainty  comes  to  an  end  when  the  disease  really 
appears.  The  muscular  debility  complained  of  in  many 
cases,  the  restless  sleep  out  of  which  the  patient  starts 
up,  his  continual  fidgetiness,  his  suspicious  breathing, 
his  sadness  and  search  after  pleasure,  and  then  his  love 
of  solitude,  must  awaken  terrible  fears  in  the  physician, 
especially  if  there  be  no  moral  causes  or  organic  lesions  to 
satisfactorily  account  for  these  symptoms.  The  intense 
thirst,  and  general  muscular  pains  and  rigors,  which 
might  at  first  be  ascribed  to  some  grave  febrile  affection, 
all  followed  by  a symptom  that  is  almost  pathognomonic 
of  hydrophobia,  namely,  a sudden  difficulty  in  swallow- 
ing liquids,  water  in  particular,  when  there  is  complete 
inability  to  drink,  and  when  this  dysphagia  is  immedi- 
ately succeeded  by  tremor  on  the  patient  carrying  some 
liquid  to  his  lips,  all  illusion  is  dispelled  and  it  becomes 
clear  that  he  is  under  the  fatal  influence  of  rabies.^^ 
Prognosis. — Hydrophobia  must  always  be  regarded  as 
one  of  the  gravest  of  all  maladies  to  which  humanity  is 
subject.  Dr.  Hammond,  Diseases  of  th?,  Nervous  Sys- 
tem, p.  654,  says : But,  although  the  prognosis  is  so 

hopeless  in  the  developed  disease,  it  is  much  more  favor- 
able as  regards  the  probability  of  the  supervention  of 
hydrophobia  from  the  bites  of  rabid  animals,  for,  of 
those  bitten  by  dogs  unmistakably  affected  with  the  dis- 
ease, not  more  than  one  in  fifteen  becomes  successfully 
inoculated.  This  liability  differs  greatly,  according  to 
the  circumstances  of  the  part  being  covered  or  not.  The 


92 


HYDROPHOBIA. 


wounds  of  the  face^  neck^  or  hands^  are  much  more 
likely  to  be  followed  by  hydrophobia  than  those  inflicted 
on  the  legs  or  feeb  when  the  virus  is  rubbed  off  by  the 
clothing  before  the  teeth  reach  the  flesh.  The  bite  of  a 
rabid  wolf  is  more  apt  to  be  followed  by  the  disease  than 
the  bite  of  a dog,  for  the  reason  that  the  first  named 
generally  seizes  the  throat  or  face.  Thus,  Trolliet  states 
that  at  Brives,  in  France,  seventeen  persons  were  bitten 
by  a rabid  wolf,  of  whom  ten  died  of  hydrophobia;  and 
of  twenty-three  bitten  by  another,  thirteen  died. 

On  the  other  hand.  Hunter  states  that  on  one  occasion 
a dog  bit  twenty  persons,  of  whom  only  one  was  inocu- 
lated. Those  first  bitten  by  a rabid  animal  are  more 
liable  to  have  hydrophobia  than  those  bitten  subse- 
quently, when  the  poison  is,  in  a measure,  exhausted. 
Probably  the  most  dangerous  wounds  are  those  which 
barely  penetrate  the  epidermis,  and  in  which,  therefore, 
the  venom  is  not  washed  away  by  any  flow  of  blood.’^ 
While  Dr.  Hammond  asserts  that  we  have  no  well- 
authenticated  instance  on  record  of  a cure  of  a case  of 
hydrophobia.  Dr.  Dolan,  p.  163,  writes : Can  we  only 

endorse  the  opinion  that  death  is  the  physician  that 
rures,  tarpon  larpt  Odvaro-,^  and  we  can  only  promote  the 
patient’s  euthanasia,  in  a manner  certainly  more  scien- 
tific and  more  humane  than  the  smothering  practices  of 
our  ancestors;  that  our  only  resort  is  to  poison  the  patient, 
cito  tuto  et  jmunde,  by  chloroform,  or  chloral  hydrate? 
We  must  emphatically  assert,  cases  of  recovery  have 
been  recorded,  and  have  taken  place ; that  the  evidence 
on  this  point  is  as  conclusive  as  the  evidence  that  such  a 
disease  as  rabies  exists ; and  to  deny  the  existence  of  such 


SYMPTOMS,  DIAGNOSIS,  PROGNOSIS. 


m 


records  of  recovery,  is  simply  to  deny  the  existence  of 
the  disease.  We  can  only  know  rabies  by  the  symptoms 
and  by  the  description  we  have  furnished  by  those  who 
have  had  cases  under  treatment. 

If  the  evidence  is  satisfactory  and  conclusive  that 
rabies  has  existed,  and,  unfortunately,  been  too  fatal,  it 
is  also  equally  satisfactory  and  conclusive  that  Dr.  Offen- 
berg  has  described  the  disease,  and  attended  a patient 
who  recovered,  and  that  Dr.  Austin  Flint  has  offered 
similar  testimony. 

We  are  not  enthusiastic  on  the  subject  of  the  efficacy 
of  Gurara;  but  we  feel  it  our  duty,  with  the  utmost 
deference,  to  enter  a protest  against  statements  which  are 
not  verified  by  fact,  and  which  strike  at  the  root  of 
medical  progress  and  medical  science.  The  injurious 
tendency  of  such  teaching  we  have  already  had  occasion 
to  animadvert  on,  and  we  have  attributed  much  of  our 
ignorance  on  the  subject  of  this  disease  to  the  influence 
exercised  by  some  of  the  older  physicians.  * * * 

We  cannot  admit  the  impossibility  of  discovering  a 
remedy,  and  we  are  not  disposed  to  write  over  the  door 
of  a patient’s  room  the  despairing  and  well-known  lines 
of  Dante : — 

‘‘Lasciate  ogni  speranza.” 

The  treatment  in  the  past  has  been,  in  the  majority  of 
cases,  irrational  and  unscientific ; the  majority  of  the 
deaths  may  be  attributed  as  much  to  the  bad  treatment 
and  the  action  of  the  medicine  administered  as  to  the 
virus  introduced  into  the  system.  Encouraged  by  the 
recoveries  that  have  taken  place,  we  venture  to  prophesy 


94 


HYDROPHOBIA. 


future  successes,  if  not  with  curara,  still  with  some  other 
remedy  wrested  by  the  skill  of  the  scientist  from  the 
grand  laboratory  of  Nature.  AVe  believe  that  there  is  not 
a poison  in  existence  for  which  there  is  not  an  antidote. 
We  have  faith  in  our  profession;  a faith  not  resting  on 
the  changing  quicksands  of  medical  theories  or  opinions, 
but  built  on  the  sterling  triumphs  of  medicine  over  dis- 
eases which  were  pronounced  by  our  ancestors  incurable. 
AVe  cannot  recognize,  then,  in  rabies,  any  special  condi- 
tions which  preclude  us  from  hoping  that  the  beneficence 
of  the  Creator,  which  enables  us  to  grapple  with  other 
diseases,  will  grant  us  similar  power  over  this  sad 
scourge  of  humanity 

The  experiments  made  with  oxygen  by  two  Russian 
physicians,  Drs.  Schmidt  and  Zebeden,  with  a well- 
authenticated  cure  of  a case  of  hydrophobia  from  its 
administration,  reported  in  the  Lyon  MMioal,  inspire 
the  hope  that  at  last  science  has  struck  the  physiological 
keynote;  and  that,  in  well-established  instances  of  the 
disease,  the  physician  may  look  with  a reasonable  assur- 
ance to  a successful  termination.  Modern  inquiry  has 
stripped  away  the  shroud  of  gloom  that,  from  earliest 
time,  has  enveloped  the  disease.  The  superstition  that 
was  bred  of  ignorance  is  routed  by  the  advance  of  intel- 
lect. If  hydrophobia  be  primarily  due  to  a blood  fer- 
ment acting  upon  the  red  corpuscles,  then  we  may  expect 
the  most  satisfactory  results  from  the  use  of  oxygen. 


TREATMENT. 


95 


CHAPTER  VI. 

TREATMENT — PRESERVATIVE,  CURATIVE,  PREVENTIVE. 

Preservative, — AVe  will  now  pass  at  once  to  a consid- 
eration of  the  means  of  preservation  and  cure  which  are 
at  present  exciting  discussion,  and  upon  which  the  best 
practice  of  the  day  is  based. 

Suction. — Bouley,  p*.  47,  thus  expresses  himself  in 
regard  to  suction : The  first  means  which  may  be  pre- 
ventive, if  applied  without  a moment’s  hesitation,  is  the 
prompt  suction  of  the  wound.  This  the  bitten  person, 
in  many  cases,  may  apply  at  once  himself,  when  the 
wound  is  convenient  for  him  to  reach  with  his  mouth. 
The  blood  which  flows  under  the  influence  of  the  suck- 
ing of  tlie  lips,  brings  away  with  it  the  virus  which 
may  have  penetrated  within  the  capillaries  of  the 
wounded  parts.  The  chances  of  the  absorption  of  this 
liquid,  if  not  destroyed,  are  at  least  considerably  re- 
duced. No  doubt  it  may  be  said,  as  an  objection,  that 
if  in  this  practice  the  virus  is  not  absorbed  through  the 
wound,  it  may  be  through  the  mouth,  the  mucous  mem- 
brane of  which  is  so  delicate.  But  this  danger  may  be 
avoided,  if,  after  each  ajiplication  of  the  mouth  to  the 
wound,  the  liquid  is  immediately  rejected.  Under  any 
circumstances,  it  seems  that  in  such  a case  there  should 
be  no  hesitation  on  the  part  of  the  sufferer  in  considering 
what  he  has  to  do,  for  most  certainly  the  chances  of  ab- 
sorption of  the  virus  are  greater  through  the  surface  of 
a flesh  wound  than  through  that  of  a healthy  mucous 


96 


HYDROPHOBIA. 


iiiembrane;  but  if,  under  the  specified  conditions,  the 
chances  of  absorption  of  the  virus  through  the  surface 
are  small,  I would  not  dare  to  say  that  they  are  entirely 
negative;  neither  can  I recommend  suction  as  a general 
practice  in  the  case  of  persons  not  in  danger.  I can 
only  recommend  it  as  a means  always  at  hand,  and 
ready  to  be  applied  when  any  other  cannot  be  had,  and 
as  one  which  might  prevent  the  terrific  danger  to  which 
bitten  persons  are  exposed  ; yet  I fear  the  responsibility 
of  the  results  to  those  who,  urged  by  affection,  might 
have  recourse  to  its  employment  for  the  benefit  of  one 
near  and  dear  to  them.^^ 

In  the  time  of  Cleopatra  suction  was  resorted  to  as  a 
remedy  against  the  venom  of  an  asp.  In  England,  in 
the  thirteenth  century,  historians  tell  us  that  Eleanor 
sucked  the  wound  of  King  Edward  I,  which  had  been 
caused  by  a poisoned  dart.  The  ancient  writers,  from 
the  time  of  Dioscorides,  all  allude  to  it,  and  Berkenhout, 
in  his  essay,  already  alluded  to,  revived  the  idea. 
The  practice  has,  in  these  modern  days,  met  with  oppo- 
sition, and  Sir  Thomas  Watson,  in  the  Nineteenth 
Century,  December,  1877,  confesses  his  disapproval  of 
it,  lest  the  helping  neighbor  rush  into  the  very  peril  he 
was  desirous  of  averting.  Lipscomb  also  condemns  the 
j>ractice,  though  the  poetic  fancy  may  be  tickled  by  the 
romance.  Concerning  this  needless  fear,  Fleming  says : 

It  may  be  objected  to  this  practice  (suction),  however, 
that  the  absorption  that  does  not  take  place  by  the 
wound  may  occur  by  the  mouth,  if  there  chance  to  be 
any  abrasion  in  that  cavity  or  on  the  lips.  But  this 
risk  may  be  largely  averted  if  care  is  taken  to  spit  freely 


TREATMENT. 


97 


after  each  aspiration.  At  any  rate^  though  such  an  ac- 
cident is  possible,  yet  it  is  so  unlikely,  that  the  wounded 
person  should  have  no  hesitation  whatever  in  at  once 
adopting  this  means ; for  assuredly  the  chances  of  ab- 
sorption of  the  ])oison  in  this  way  are  infinitely  smaller 
than  they  are  if  it  is  left  in  contact  with  the  fresh 
wound 

Dr.  Dolan  is  much  more  energetic:  We  are  diamet- 
rically opposed  to  this  point,  and  must  unhesitatingly 
recommend  it.  We  agree  with  Fleming  [Veterinai^y 
Journal,  p.  16,  1878),  that  suction  for  the  removal  of 
poisons  from  wounds  has  been  practiced  from  time  im- 
memorial, and  yet  there  is  no  evidence  whatever  to 
prove  that  it  has  been  a fatal  practice.  On  the  contrary, 
not  only  has  the  operator,  in  every  recorded  instance, 
escaped  danger,  but  the  operation  itself  appears  to  have, 
in  many  cases,  preserved  the  life  of  the  wounded  indi- 
vidual. The  poison  is  not  retained  in  the  mouth,  but 
is  immediately  and  forcibly  expelled,  so  that  if  there  be 
any  danger  of  absorption  by  the  mouth,  or  by  an  abra- 
sion, the  chances  of  infection  are  infinitesimally  small. 
Even  though  the  risk  was  greater  than  it  is,  it  should 
not  deter  the  bystander  from  attempting  a noble  and  de- 
voted act.  * * * * Suction,  then,  should  be 

energetically  and  speedily  employed,  either  by  the  bitten 
individual  or  the  bystander,  care  being  taken  to  spit 
freely  after  each  application  of  the  mouth,  and  subse- 
quently the  mouth  may  be  rinsed  out  with  some  fluid, 
as  water,  milk,  vinegar,  or  beer,  or  spirits,  which  are 
generally  attainable,  even  though  water  may  be  scarce. 
It  must  ever  be  remembered,  as  Fleming  says,  that  time 


98 


HYDROPHOBIA. 


is  a most  important  element,  and  waiting  for  caustics, 
cupping  glasses,  or  the  surgeon’s  scalpel,  may  be  synony- 
mous with  waiting  for  death.” 

EXPRESSION,  WASHING,  COMPRESSION  AND  CUPPING. 

Squeezing  or  expression  of  the  wound  should  always 
be  resorted  to,  in  conjunction  with  suction,  in  order  to 
increase  bleeding.  Washing  the  wound  with  cold  water, 
or,  as  Bouley  suggests,  with  chlorinate  of  soda,  is  a wise 
measure.  Fleming  refers  to  an  instance  wiiere  several 
persons  escaped  inoculation  after  being  bitten  by  a rabid 
bear,  by  being  compelled  to  swim  a river.  A handker- 
chief, bandage  or  leather  strap  may  be  applied  between 
the  bitten  part  and  the  body,  to  prevent  the  virus  from 
entering  the  general  circulation.  It  is  a useful  adjunct 
to  suction,  cupping,  etc.  Cupping  is  so  simple  that  any 
one  may  practice  it.  In  lieu  of  a more  suitable  appara- 
tus, an  empty  bottle,  from  which  the  air  has  been  ex- 
hausted, may  be  applied  over  the  wound,  and  bleeding 
established,  by  incisions  made  with  an  ordinary  pocket 
knife. 

Cauteinzation, — Having  resorted  to  one  or  the  other 
of  the  foregoing  plans,  we  should  have  recourse  to  cau- 
terization as  soon  as  possible.  An  objection  has  been 
raised  against  the  hot  iron,  that  the  eschar  formed  on  the 
surface  or  upper  part  of  the  wound  might  shut  in  some 
portion  of  the  virus,  but  the  physician  will  modify  his 
treatment  according  to  circumstances. 

Bouley  says : — 

✓ 

^‘From  the  documents  already  mentioned,  it  is  proved  that  the 
cauterization  of  the  wounds  with  red-hot  iron,  made  with  the  great- 


TREATMENT. 


99 


est  thoroughness,  and  in  the  shortest  possible  time  after  the  inocu- 
lation, has  proved  the  most  certain  prevention. 

“ I cannot  say,  and  I fear  it  would  be  temerity  to  attempt  to  indi- 
cate, within  wdiat  limit  of  time  the  absorption  of  virulent  saliva 
takes  place  when  brought  in  contact  with  a wound  by  a bite,  or 
otherwise.  The  results  of  experiments  in  this  direction  are  not  as 
yet  sufficient  to  enable  us  to  decide  understandingly.  But  what  can 
be  said  without  fear  of  mistake  is,  that  cauterization  cannot  be 
applied  to  an  existing  wound  too  soon,  that  the  red-hot  iron  is 
preferable  to  all  other  means,  and  that  it  is  better  to  apply  it  in 
excess  than  in  a timorous  way. 

“This  operation  does  not  require,  positively  speaking,  the  ser- 
vices of  a surgeon,  at  least  not  when  the  wounds  are  superficial,  or 
when,  having  penetrated  only  to  a moderate  depth,  they  are 
altogether  in  the  flesh. 

“ It  is  easy  to  improvise  instruments  which  may  be  used  for  this 
purpose : an  iron  bar,  a fluting-iron,  a poker,  any  rod  of  iron,  in 
fact,  even  the  blade  of  a knife,  or  those  of  a pair  of  scissors,  all 
may  answer  the  purpose  ; but  it  is  preferable  if  the  object  is  round 
rather  than  flat,  for  it  holds  and  retains  the  heat  better.  In  using 
it,  the  iron  must  be  heated  to  a white  heat,  and  when  applied  to  the 
wound  it  is  to  be  held  there  with  a firm  and  steady  hand,  carefully 
turning  it  through  the  whole  length  and  to  the  full  depth  of  the 
wound,  for  absolute  certainty.  The  cauterization  being  done  once, 
it  is  well  to  repeat  it  a second  time. 

“The  intensity  of  the  pain  is  here  of  secondary  consideration; 
no  matter  how  intense  the  sufferings  of  the  moment  may  be,  when 
we  consider  the  importance  of  the  object  at  stake.  Indeed,  people 
generally  have  a greater  dread  of  the  pain  thus  caused  than  there 
is  any  occasion  for.  This  pain  is  entirely  endurable,  especially 
when  the  parts  in  immediate  contact  with  the  cautery  are  carbon- 
ized. It  seems,  indeed,  if  I can  credit  the  report  made  to  me  by 
M-  Leblanc,  of  Paris,  who  spoke  from  personal  experience,  that 
cauterization  of  a rabid  wound  would  be,  I will  not  say  pleasant, 
but  not  without  a certain  satisfaction,  resulting  from  the  idea  of  the 
good  that  it  will  secure,  and  the  relief  to  the  mind.  When  a cautery 
is  needed,  and  the  hot  iron  cannot  be  obtained  immediately,  one 
may  cauterize  the  wounded  parts  by  using  gunpowder,  as  appears 
from  information  received  by  the  Academy  of  Medicine  through  a 


100 


HYDROPHOBIA. 


M.  Maniere,  wlio  for  fifteen  years  lived  in  Hayti.  Rabies  is  a 
frequent  disease  in  that  climate,  and  is  observed  in  all  seasons, 
but  it  is  not  followed  by  fatal  results  in  proportion  to  the  number 
of  bites,  because  every  one  there  appears  to  know  the  way  to  pre- 
vent it.  As  soon  as  a wound  is  received  it  is  filled  with  gunpow- 
der ; this  is  ignited,  and  thus  a very  efficacious  cauterization  is 
instantly  produced,  which  can  be  applied  at  once,  the  powder 
being  easily  obtained.” 

The  thermo-cautery  of  Paquelin  may  be  used  with 
great  advantage. 

Caustics, — Nearly  all  the  caustics  of  which  we  have 
knowledge  have  been  more  or  less  lauded.  The  strong 
fluid  acids,  such  as  acetic,  nitric,  hydrochloric,  and  car- 
bolic acid,  and  such  escharotics  as  nitrate  of  silver,  per- 
chloride  of  iron,  muriate  of  antimony,  and  corrosive 
sublimate  have  all  been  employed.  Dr.  Geo.  B.Shattuck, 
in  the  Boston  Medical  and  Surgical  Journal,  February 
7th,  1878,  thinks  that  the  lunar  caustic  would  be  found 
more  useful  than  the  hot  iron,  in  unpracticed  hands,  and 
in  many  wounds.^^  Lafosse  states  that  the  cautery 
should  not  be  preferred  to  the  exclusion  of  caustics,  ex- 
cept in  cases  in  which  the  wounds  are  deep,  or  in  regions 
such  as  those  of  the  mouth  or  nose,  where  solid  or  fluid 
caustics  might  prove  dangerous.  It  is  also  well  to  note 
that  Constantinescu  (Fleming)  states  that  the  nitrate  of 
silver,  alcohol  and  ammonia,  applied  to  wounds  some 
moments  even  after  they  were  inflicted,  have  not  pre- 
vented the  development  of  hydrophobia.  Of  the  solid 
caustics,  Blaine  and  Youatt  prefer  the  nitrate  of  silver. 
It  should  be  applied  thoroughly,  immediately  after 
receiving  the  wound.  The  ^^potassa  fusa^’  is,  however, 
more  prompt  and  more  destructive  in  its  action. 


TEEATMENT. 


101 


Sometimes  it  may  be  necessary  to  enlarge  the  wound 
and  insert  probes  dipped  in  melted  caustic  potash ; or 
we  may  use  the  nitrate  of  antimony,  of  which  Sabatier 
speaks  very  highly.  Lint  soaked  in  iodine  has  had  its 
advocates.  The  caustic  potash,  thoroughly  applied,  is, 
beyond  question,  the  most  efficacious  remedy  that  we 
have  after  the  actual  cautery. 

Exeisiov, — Great  care  should  be  taken,  in  the  excision 
of  wounds  of  this  nature,  that  the  blade  of  the  knife  be 
not  instrumental  in  the  diffusion  of  the  virus,  and  that 
every  particle  of  contaminated  flesh  be  excised.  Flem- 
ing advises  two  incisions,  one  on  each  side  of  the  wound, 
forming  an  ellipse.  Mr.  Abernethy  recommended  the 
following  plan  : the  cell  into  which  a penetrating  tooth 
has  gone  must  be  cut  out.  Let  a skewer  be  shaped, 
as  nearly  as  may  be,  into  the  form  of  the  tooth;  and 
then  be  placed  in  the  cavity  formed  by  the  tooth ; and 
next  let  the  skewer  and  the  whole  cell  containing  it  be 
removed  together,  by  an  elliptical  incision.  If  excision 
be  rendered  dangerous  from  the  proximity  of  the  wound 
to  blood  vessels,  nerves,  or  tendons,  we  must  resort  to 
caustics.  Jesse  Foote  (op.  cit.)  believed  that  excision  of 
the  bitten  part  was  the  only  sure  method  of  prevention. 
He  illustrates  his  opinion  by  several  cases,  and  gives  the 
following  list  of  the  time  when  excision  was  performed 
in  his  cases  : — 

Case  I.  After  32  to  35  hours. 

Case  II.  After  68  hours. 

Case  III.  After  12  hours. 

Case  IV.  At  once. 

Case  Y.  x\fter  72  hours. 


102 


HYDROPHOBIA. 


Case  VI.  After  20  hours. 

Case  Yii.  After  6 hours. 

Case  viii.  At  once. 

Results  of  Cauterization, — I am  indebted  to  Fleming 
for  the  following  particulars:  We  have  but  little  means 
of  ascertaining  to  what  extent  cauterization  of  the 
wounds  inflicted  by  rabid  animals  has  been  really  suc- 
cessful^ in  a large  number  of  instances^  our  experience  in 
this  country  being  limited  to  individuals,  here  and  there, 
whose  cases  have  chanced  to  be  reported.  But  M.  Bou- 
ley,  impressed  with  the  great  interest  that  belongs  to 
this  question,  has  endeavored  to  make  the  most  of  the 
statistics  available  to  him,  and  has  given  the  result,  in 
the  following  terms  (quoted  in  Chapter  iv),  of  115 
cases  of  hydrophobia  terminating  in  death,  in  France. 
Tardieuhas  tabulated  them  as  follows: — 


Years. 

Died  of 
Hydrophobia. 

Not 

Cant’d 

Tardy 

Cauter’n. 

Insufficient 

Cauter’n. 

1852,  ’53,  ’54, 

44 

26 

18 

0 

1855, 

21 

11 

5 

5 

1856, 

20 

11 

6 

3 

1857, 

13 

10 

3 

0 

1858, 

17 

6 

5 

6 

115 

64 

37 

14 

In  Algeria,  out  of  the  16  cases  of  immunity  already 
referred  to,  14  had  the  wounds  inflicted  by  rabid  animals 
cauterized  more  or  less  promptly ; in  two  instances  three 
persons  were  cauterized  twenty-four  hours  after  being 
wounded,  and  a fourth  in  thirty-six  hours.  The  follow- 
ing table  gives  the  details  of  the  16  cases  : — 


TREATMENT. 


103 


Immunity  after  immediate  cauterization  with  hot  iron  7 

‘‘  gunpowder  1 

Immunity  after  late  appearance,  cauterized  with  hot 


iron 1 

Immunity  after  at  least  24  hours 3 

36  hours 1 

u u in^niediate  cauterization  with  muriate 

of  antimony  after  3 hours 1 

Immunity  without  adopting  precautions 2 


Thus  it  will  be  seen  that  one-half  the  cases  of  immu- 
nity might  be  supposed  to  be  due  to  immediate  cauteri- 
zation, three-eighths  to  tardy  cauterization,  and  one-eighth 
escaped  without  any  treatment. 

Of  the  47  deaths  tabulated  by  Roucher  as  occurring 
in  Algeria,  we  find  that  their  relations  with  preventive 
or  preservative  measures  are  as  follows : — 


Died  without  wounds  having  been  cauterized 25 

indications  of  precautions 10 

after  tardy  and  incomplete  cauterization  with 

hot  iron 2 

cauferization  with  hot  iron 5 

nitrate  of  silver 1 

u u itn mediate  cauterization  with  ammonia, 

supplemented  by  the  hot  iron,  and  an 

hour  and  a half  subsequently 1 

immediate  cauterization  with  ammonia...  2 
■ “ hot  iron 1 


In  the  47  deaths  only  one  occurred  after  immediate 
cauterization  with  the  hot  iron  ; 12  were  preceded  by 
delayed  or  insufficient  cauterization ; and  35  had  not 
been  submitted  to  any  preventive  treatment ; for  it  is 
very  probable  that  in  the  10  cases  which  afford  no  indi- 
cation of  precautions  having  been  adopted,  none  were 


104 


HYDROPHOBIA. 


resorted  to ; so  that  of  the  37  cases  allowed  to  take  their 
natural  course,  there  were  2 of  immunity  and  35  deaths, 
or  a mortality  of  94.6  per  cent.  Of  the  9 in  which 
cauterization  with  the  hot  iron  was  immediately  em- 
ployed, there  was  only  one  fatal  case,  or  a mortality  of 
11  per  cent.;  and  of  the  16  cauterized  after  some  days, 
or  in  a manner  more  or  less  imperfect,  there  were  10 
deaths,  or  a mortality  of  62.5  per  cent.  Among  the 
fatal  cases  whose  history  was  more  or  less  known,  there 
was  only  one  in  which  the  wound  had  been  at  once 
treated  with  the  actual  cautery,  and  another  in  which 
ammonia  was  applied  first  and  the  hot  iron  some  time 
afterward.  In  three  instances  there  was  a delay  of  nine 
and  twelve  hours,  and  in  other  three  of  some  hours.  In 
three  more  of  the  47  cases  cauterization  was  incompletely 
effected  by  ammonia  or  nitrate  of  silver;  in  one  case 
cauterization  was  only  resorted  to  after  two  days;  and 
twice  the  wounds  were  dressed  immediately  with  liquid 
ammonia.  The  only  patient  who  died  after  having  his 
wounds  immediately  cauterized  with  the  hot  iron  was 
believed  to  have  been  saved,  as  he  enjoyed  excellent 
health  for  six  and  a half  months,  and  in  that  time  had 
taken  part  in  the  expedition  against  the  Kabyles,  in  1851, 
and  returned  quite  well.  In  the  two  which  had  the 
wounds  dressed  immediately  with  liquid  ammonia,  the 
period  of  incubation  extended  to  116  and  130  days;  a 
circumstance  which  might  give  rise  to  the  supposition 
that  caustics  have  a retarding  influence  in  the  develop- 
ment of  the  disease.  Three  persons  mentioned  by 
Toussaint,of  Algeria,  who  had  been  bitten  and  had  their 
wounds  cauterized — two  immediately,  and  one  the  next 


TREATMENT. 


105 


clay — escaped  the  consequences  ; while  a fourth  person, 
who  did  not  have  his  wounds  attended  to,  died  of  hy- 
drophobia. Hugo  speaks  of  sev^en  persons  who  were 
bitten  by  a rabid  dog;  three  had  their  injuries  cauterized 
twenty-four  hours  afterward,  and  the  other  four  cauter- 
ized themselves  with  two  pieces  of  iron  heated  in*  the 
fire ; all  escaped.  The  same  dog  attacked  a child  twelve 
years  old,  and  its  wounds  not  being  attended  to,  it  died 
of  hydrophobia.  Youatt,  who  trusted  to  caustics,  and 
who  had  himself  been  bitten  seven  times,  says  that  he 
had  used  caustics  for  the  wounds  of  more  than  four 
hundred  persons  who  were  bitten  by  dogs,  of  whose  dis- 
ease there  could  be  no  doubt,  and  that  not  one  of  these 
became  affected ; and  a surgeon  of  St.  George’s  Hospital 
told  him  that  ten  times  that  number  had  undergone  the 
operation  of  excision  there,  after  having  been  bitten  by 
rabid  or  suspected  dogs,  and  it  was  not  known  that  any 

of  these  persons  had  become  diseased. 

8 


106 


HYDROPHOBIA. 


/ 


CHAPTER  VII. 

TREATMENT  CONTINUED — CURATIVE. 

Leaving  for  future  consideration  the  various  medica- 
ments which  have  been  resorted  to  in  the  treatment  of 
hydrophobia,  I shall  confine  myself  in  this  chapter  to 
such  remedies  as  have,  of  late,  excited  very  general  inter- 
esty  and  from  the  administration  of  which  we  may  look 
for  the  happiest  results.  In  this  connection,  it  will  be 
well  to  mention,  also,  the  general  treatment,  mental  and 
physical,  which  are  valuable  accessories  in  restoring  a 
just  economy  betAveen  cerebral  and  bodily  function. 
The  remedies  upon  which  the  practitioner  must  base  his 
treatment  are  curara,  oxygen,  and  Turkish  baths.  Calo- 
mel, sulphate  of  soda,  magnesia,  carbolic  acid,  atropia, 
bromide  of  potassium,  chloral  hydrate,  chloroform,  etc., 
have  all  been  used,  sparingly  and  heroically,  and  they 
have  all  proved  signally  unsuccessful.  For  in  those 
instances  in  which  cases  of  cure  of  hydrophobia  have 
been  reported  as  due  to  the  admin istration  of  calomel,  I 
am  led  to  infer  that  they  were  post  hoc  and  not  propter 
hoc,  while  others  are  not  sufficiently  well  authenticated 
to  be  trusted.  I am  not  an  enthusiast  in  regard  to  cu- 
rara; neither  am  I disposed  to  pin  my  faith  to  oxygen, 
because,  in  advocating  the  exclusive  use  of  either,  or 
both,  disregarding  entirely  the  effects  Avhich  have  been 
obtained  from  other  remedies,  be  their  results  ever  so 
unsatisfactory,  I can  see  how  much  danger  would  result 
to  the  profession.  The  number  of  cases  treated  by 


TEEATMENT. 


107 


oxygen  is  so  very  small,  tliat  it  would  be  presumptuous 
to  draw  any  absolute  conclusions  in  relation  to  it.  More- 
over, when  we  consider  that  during  the  civil  war  in  the 
United  States,  what  enthusiasm  surrounded  oxygen  in 
the  treatment  of  typhoid  fever,  and  how  this  enthusiasm 
as  suddenly  died  out,  not  a single  case  having  been  bene- 
fited by  it,  it  would  be  premature  and  irrational  to  pro- 
nounce definitely  upon  its  usage; 

Carara, — The  following  literature  upon  the  subject 
of  curara,  is  of  interest : — 

Geheilte  Hundsv/uth  beim  Menschen — Ein  Beitrag  Zur  Kennt- 
niss  des  Curare,  von  Dr.  Ad.  OfFenberg,  Praktische  Arzt  in  Wick- 
rath  (Rheinpreussen)  Bonn,  1879.  Wegen  der  Einzelheiten  liber 
die  Wirkungsweise  des  curare  mbge  man  die  neueren  Hand- 
blicher,  z.  B.  Nothnagel  u.  Rossbach  Arzneimittellehre,  1878, 
pp.  691-G96;  oder  L.  Hermann  Toxicologie,  1874,  pp.  299-310, 
nachsclilagen.  Sitzungsberichte  der  Niederrheinischen  Gesell- 
scliaft  fur  Xatur — u.'  Heilkunde  in  Bonn,  Sitzung  vom  17  Mai, 
1867.  Nothnagel,  Arzneimittellehre,  ii,  aufl.;  1874,  p.  86.  Eulen- 
berg,  die  hypod.  Inj.  d.  Arzneimittel,  1875,  p.  232.  Nouveaux 
Medicaments,  1865,  p.  539.  Formulaires  des  Medicaments  nou- 
veaux, p.  470.  F.  V.  Niemeyer,  Lehrbuch  d.  spec.  Path.  u.  Ther. 
8 Aufl.,  1869.  Nach.  Eulenberg  Hypod.  Inj.  d.  Arzneimittel,  p. 
230.  Bollinger  Die  Wuthkrankheit  ” inBd.  iii — des  Handbuchs 
der  spec.  Path.  u.  Therapie,  von  v.  Ziemssen,  1874,  p.  571.  Eu- 
lenberg, Lehrb.  d.  Nervenkrankheiten  11.  Aufl.  Th.,  p.  602,  1878. 
Die  Pharmacopoeia  Helvetica  Supplementum,  p.  142.  Binz.  Grund- 
zUge  d.  Arzneimittellehre  11,  Aufl.  p.  18.  Eulenberg,  Preuss. 
Medicinal- Kalender,  1879,  p.  52.  Beigel,  Die  hypod.  Inj.  d.  Arz- 
‘ neimittel,  iii  Aufl.,  p.  222.  Preyer,  Verhandlungen  des  naturhis- 
torischen  Vereins  der  Preuss.  Rheinlande  u.  Westfalens,  24  Jahr- 
gang,  p.  71.  Der  Preuss.  Med.  Kalender,  1878  u.  1879,  p.  12.  Dr. 
Steiner,  das  Amerikanische  Pfeilgistcurare.  Dr.  Ritter  von  Lobo- 
sitz  in  der  Wiener  Med.  Wochenschrift,  1879,  No.  4.  Dragen- 
dorff  “Manuel  de  Toxicologie.” 


108 


HYDROPHOBIA. 


/ 


Reveil  (Formulalres  des  Medicaments  nonveaux^  p. 
470^)  has  seen  curara  employed  successfully  in  a case  of 
hydrophobia,  in  a child,  at  the  Children's  Hospital. 
Five  milligrams  of  curara  were  injected  at  three  different 
times,  and  the  more  alarming  symptoms  disappeared 
within  two  hours.  The  solution  employed  was: — 


B. — Curara3 0.05 

Aq.  purae 25.0 


Dr.  Offenberg  says  : — 

‘‘DerPrm.s5.  Med,  Kalender,  1878  u.  1879,  p.  12,  gibt  auffalliger 
Weise  flir  das  curare  geringere  Dosen  an,  als  fur  das  Curarinum 
sulphuricum,  naemlicli  fur  ersteres,  0.0012-0.002  ; flir  letzteres 
aber,  0.002-0.01.  Man  sieht  daraus,  welche  Verwirrung  in  der 
Curare  Angelegenheit  noch  herrscht.” 

From  Dr.  Dolarfs  work  we  find  that  Prof.  Sewell 
was  the  first  who  suggested  the  idea  of  curara,  and 
Waterton,  who  went  in  quest  of  the  poison,  and  acquired 
it  in  its  pure  state,  at  his  own  expense,  and  at  the  cost 
of  his  own  health,  has  generously  given  him  the  credit 
of  the  suggestion.  Sewell,  on  the  authority  of  Water- 
ton,  is  said  to  have  declared  before  Sir  Joseph  Banks 
and  a large  company  of  scientific  gentlemen,  that,  were 
he  unfortunate  enough  to  be  bitten  by  a mad  dog,  and 
become  infected  with  rabies,  he  would  not  hesitate  one 
moment  in  having  the  woorali  poison  applied,  as  he  felt 
confident  that  the  application  of  it  would  prove  success- 
ful. The  history  of  this  poison  is  most  interesting. 
Taylor,  in  his  classic  work  on  poisons,  quotes  Waterton^s 
account,  and  thus  offers  us  some  guarantee  of  the  vera- 
city of  the  much  abused  naturalist.  We  shall  give  an 
abridged  account  from  the  original  work,  from  the  folio 


TREATMENT. 


109 


edition,  1825.  In  the  month  of  April,  1812,  Watertou 
left  the  town  of  Stabrock  to  travel  through  the  wilds  of 
Demerara  and  Essequibo,  with  the  chief  object  of  col- 
lecting a quantity  of  the  strongest  woorali  poison  ; and 
after  penetrating  into  the  country  where  the  poisonous 
ingredients  grew,  where  the  composition  was  prepared 
and  used,  success  attended  his  adventure.  After  121 
days  he  acquired  all  the  information  about  it,  and  a sup- 
ply which  he  brought  back  with  him  to  England.  The 
poisonous  extract  is  made  from  the  woorali  vine,  a bitter 
root,  two  kinds  of  bulbous  plants,  two  species  of  ants, 
the  strongest  Indian  pepper,  and  the  powdered  fangs  of 
the  Labaria  and  Counacouchi  snakes.  The  Maracoushi 
Indian  makes  the  best  preparation.  Having  found  the 
necessary  ingredients,  the  Indian  scrapes  the  woorali 
vine  and  the  bitter  root  into  thin  shavings,  and  puts 
them  into  a kind  of  colander,  made  of  leaves;  this  he 
holds  over  an  earthen  pot,  and  pours  water  on  the  shav- 
ings ; the  liquor  which  comes  through  has  the  ap|)ear- 
ance  of  coffee.  When  a sufficient  quantity  has  been 
obtained,  the  shavings  are  thrown  aside.  He  then 
bruises  the  bulbous  stalks,  and  squeezes  a proportionate 
quantity  of  their  juice  through  his  hands  into  the  pot. 
Lastly,  the  snake’s  fangs,  ants,  and  pepper  are  bruised 
and  thrown  into  it.  It  is  then  placed  on  a slow  fire, 
and,  as  it  boils,  more  of  the  juice  of  the  woorali  is  added, 
according  as  it  may  be  found  necessary,  and  the  scum 
is  taken  off  with  a leaf.  It  remains  on  the  fire  till  re- 
duced to  a thick  syrup  of  a deep  brown  color.  As  soon 
as  it  has  arrived  at  this  state,  a few  arrows  are  poisoned 
with  it,  to  try  its  strength.  If  it  answer  the  expectations. 


110 


HYDEOPHOBIA. 


it  is  poured  into  a calabash,  or  a little  pot  of  Indian 
manufacture,  which  is  carefully  covered  with  a couple 
of  leaves,  and  over  them  a piece  of  deer  skin,  tied  round 
with  cord. 

They  keep  it  in  the  dryest  part  of  the  hut,  and  from 
time  to  time  suspend  it  over  the  fire  to  counteract  the 
effect  of  dampness.  The  operation  of  making  it  was 
gloomy  and  mysterious.  No  women  or  young  girls  were 
present,  lest  the  Zabahout,  or  Evil  Spirit,  should  do 
them  harm.  The  shed  under  which  it  had  been  boiled 
was  pronounced  polluted,  the  pot  must  never  have  held 
anything  before,  while  the  maker  had  to  fast  as  long  as 
the  operation  lasted.  We  may  now  consider  that  all  the 
ingredients  mentioned  are  not  necessary  to  produce  the 
effects  of  the  poison,  but  that  they  were  added  through 
the  superstitious  feelings  and  customs  of  the  natives. 
According  to  Waterton  and  Taylor — 

1.  The  extract  is  so  miscible  with  water,  that  the 
slightest  moisture  dissolves  it;  hence  it  speedily  diffuses 
itself  when  introduced  into  a wound. 

2.  The  symptoms  are  stupor  and  j)aralysis;  it  does 
not  produce  any  apparent  effect  until  after  the  lapse  of 
one  or  two  minutes,  and  the  wounded  animal  apparently 
dies  without  a struggle  and  without  pain. 

3.  The  flesh  of  the  animal  thus  killed  may  be  used  as 
food. 

4.  The  dose  must  be  proportioned  to  the  size  of  the 
animal. 

5.  Like  the  serpent  poison,  it  is  active  when  intro- 
duced into  a wound,  but  almost  inert  when  taken  into 
the  stomach.  (Bernard.) 


TKEATMENT. 


Ill 


6.  Animals  poisoned  by  it  have  been  restored  by 
keeping  up  artificial  respiration,  as  instanced  by  the 
experiments  at  Nottingham,  England,  in  which  Dr. 
Sibson  took  part. 

7.  The  extract  retains  its  power  for  an  indefinite 
period,  but  unless  kept  dry  it  is  liable  to  become  weak- 
ened in  its  properties. 

8.  The  effect  is  to  destroy  the  motor  power  of  the 
nervous  system,  and  the  observations  of  Kolliker  and 
Pelikau  show  that  its  action  is  the  opposite  to  that  of 
strychnia.  M.  Bernard  remarks  that  there  is  no  direct 
relation  between  the  chemical  character  of  a substance 
and  its  physiological  effects.  The  same  or  similar  char- 
acters may  exist  in  two  bodies — curarina  and  strychnia 
— of  which  the  physiological  effects  are  not  only  differ- 
ent, but  antagonistic. 

9.  We  may  mention,  as  a memorandum  to  be  borne  in 
mind,  that,  according  to  Taylor,  curara,  which  has  but 
a slight  action  when  swallowed,  would,  however,  give 
the  chemical  reactions  of  strychnia  in  the  stomach,  and 
thus  induce  some  chemists  to  swear  that,  beyond  all 
doubt,  strychnia  was  present,  and  that  the  person  must 
have  died  from  it. 

In  taking  leave  of  Waterton  and  his  woorali,  we  must 
direct  attention  to  the  following:  remarks  made  by  him 
in  1844:— 

. It  is  an  acknowledged  fact  that  the  art  of  medicine  has  hitherto 
been  unable  to  arrest  the  fatal  progress  of  confirmed  hydrophobia. 
This  being  the  case,  it  is  both  wise  and  expedient  to  give  the 
sufferer  a chance  of  saving  his  life  by  the  supposed,  although,  as 
yet,  untried,  efficacy  of  the  woorali  poison,  which,  worst  come  to 
the  worst,  would,  by  its  sedative  and  narcotic  qualities,  render 


112 


HYDROPHOBIA. 


death  calm  and  composed,  and  free  from  pain  ; a circumstance  not 
to  be  expected  under  the  ordinary  treatment,  or  no  treatment  at 
all,  of  this  ungovernable  and  fatal  malady.” 

The  woorali  of  the  present  day  is  differently  pre- 
pared from  that  of  the  Indian  preparation.  It  is  called 
curara,  and  has  many  synonyms : ourari,  urari,  woorari, 
woorara,  wourali,  wouraly.  Besides  the  writers  we 
have  mentioned  — Waterton,  Taylor,  Bernard  — who 
have  described  this  poison,  the  most  recent  authority  (at 
the  time  of  Dr.  Dolan^s  writing)  is  Schomburgh,  who 
states  that  it  consists  alone  of  vegetable  matter,  chiefly 
of  an  extract  of  the  bark  of  strychnos  toxifera  (N.  O. 
Loganiacese),  a tree  found  in  Guiana.  Waterton,  as 
mentioned,  describes  his  woorali  poison  as  soft,  while 
other  writers  speak  of  the  necessity  of  keeping  it  in  a 
])erfectly  dry  state.  Taylor  [On  Poisons,  1875)  says 
that  ^^curara  is  a brownish-black,  brittle  substance,  hav- 
ing the  appearance  of  Spanish  liquorice.  It  dissolves 
slowly  in  cold  water,  but  rapidly  when  heated,  produc- 
ing a turbid  brown  liquid ; this  becomes  clear  upon  fil- 
tration.^^ ^ ^ ^ Although  curarine,  the  alkaloid  of 

curara,  possesses  some  of  the  characteristics  of  strych- 
nine, sufficient  proof  has  been  obtained  [Telia,  Pharm, 
Journ,,  vol.  xi,  p.  213)  that  it  is  totally  distinct  from 
the  latter,  and  that  their  action  is  antagonistic. 

Preyer  was  the  first  to  isolate  curarine  in  the  crystal- 
line form  ; according  to  him  it  has  the  formula  Cjo  Hig  N. 
It  is  very  hygroscopic ; has  a very  bitter  taste ; crystal- 
lizes in  colorless  four-sided  prisms ; dissolves  freely  in 
water  and  alcohol,  less  easily  in  chloroform  and  amyl 
alcohol;  and  is  insoluble  in  anhydrous  ether,  benzol, 


TKEATMENT. 


113 


turpentine,  and  carbon  disulphide.  It  acquires  a splen- 
did and  permanent  blue  color  in  contact  with  sulphuric 
acid,  purple  red  with  nitric  acid,  and  violet  with  potas- 
sium dichromate  and  sulphuric  acid  (like  that  of  strych- 
nia, but  more  permanent).  Its  hydrochloride,  nitrate, 
sulphate,  and  acetate  are  crj^stallizable.  Dragendorff 
also  finds  that  curarine  is  quite  distinct  from  strychnine, 
and  that  a very  active  curara  occurs  in  commerce,  in 
which  neither  strychnine  nor  brucine  can  be  detected. 

The  syringe  should  be  reserved  for  the  use  of  curara 
alone,  and  the  surgeon  should  use  every  precaution,  so 
as  not  to  injure  himself. 

Dr.  Offenberg  writes : ‘‘  Das  Eulenburgh^sche  Recept, 
0.1  curarinum  sulfuricum  in  5.0  aqua  kostet  demnach 
fiber  30.0  Mark.  In  den  vorhin  erwahnten  in  Muns- 
ter beobachteten  Falle  von  Tetanus  wurde  im  Ganzen 
0.435  Curarinum  sulfuricum  verbraucht,  was  130  Mark 
ausmachte.  Die  Erfahrung  lehrt  jedoch,  dass  solche 
Stoffe  nur  so  lange  theuer  sind,  als  sie  nur  selten  verlangt 
werden.’^ 

In  the  Dublin  Medical  Press,  p.  575,  1862,  is  the 
following  case  of  Bossi : — 

Result  and  Time  of  Attack. — 1 08  days  after.  Fatal 
in  sixty-seven  hours. 

Treatment. — Curara  was  used.  In  twenty-seven 
hours,  forty-one  injections  were  given  with  the  syringe 
of  Pravaz.  Each  containing  \\  gram  of  curara  dis- 
tilled in  distilled  water;  18f  centigrams  were  there- 
fore injected. 

Remarks. — A commission  was  appointed  at  the  Milan 
Hospital,  for  the  purpose  of  testing  the  remedy — wou- 


114 


HYDKOrHOBIA. 


rail  or  curara ; it  has  bten  tried  in  hydrophobia^  but 
without  good  results,  though  we  have  three  cases  re- 
ported which  recovered  after  its  use.  The  following 
are  the  terms  in  which  the  commission  embodied  the 
result  of  their  report  in  two  cases : — 

1.  In  the  case  of  Bossi  there  was  no  cauterization 
Broggi  was  cauterized  simply  with  nitrate  of  silver, 
seven  hours  after  the  bite. 

2.  The  prodromic  symptoms  were  manifested  in 
Broggi  fifty-eight  days  after  the  introduction  of  the 
virus. 

3..  The  duration  of  the  disease  from  its  development 
to  death,  in  Broggi,  was  103  dnys. 

4.  At  no  moment  did  the  curara  appear  to  act  on  the 
rabid  symptoms. 

5.  In  both  cases  there  was  profuse  perspiration,  and 
in  Bossi  a marked  but  passing  action  on  the  circulation, 
evidenced  by  a quickening  of  the  pulse.  The  autopsy 
showed  in  both  cases  red  coloration  and  fluidity  of  the 
blood. 

This  poison  is  so  deadly  that  the  greatest  care  must 
be  exercised  by  the  operator,  not  only  as  regards  his  pa- 
tient, but  in  order  that  he  himself  may  not  be  inocu- 
lated, for  the  smallest  quantity  coming  in  contact  with 
a scratch  may  give  rise  to  serious  results.  As  a remedy 
for  hydrophobia,  the  injections  should  be  small  and  fre- 
quently repeated,  and  so  timed  that  the  physiological 
effects  may  be  obtained  in  the  interval. 

Dr.  Watson,  of  Jersey  City,  in  the  Amerioan  Journal 
of  M^Aical  Sciences,  July,  1876,  reports  an  instance 
which  was  regarded  by  him  and  by  Prof.  Austin  Flint, 


TKEATMENT. 


115 


Sr.,  as  a pure  case  of  hydrophobia.  The  dog  was  mad, 
and  a servant  girl,  who  was  bitten  at  the  same  time  and 
by  the  same  animal,  died  from  hydrophobia.  Curara 
was  employed.  The  doses  were  augmented  from  j\  grain, 
i grain,  to  ^ grain,  when,  after  the  third  injection,  the 
unfavorable  symptoms  subsided.  Dr.  Dolan  also  reports 
the  following : Female,  set.  24,  bitten  by  a dog  suspected 
rabid.  The  wound  was  burnt  with  caustic  soda  three 
days  afterwards : — 

RESULT  AND  TIME  OF  ATTACK.  EIGHTY  DAYS  AFTERWARD  AND 
RECOVERY. 

Treatment. — After  having  tried  the  injection  of  morphia  and 
inhalations  of  chloroform  without  any  benefit,  it  was  decided  to 
try  full  doses  of  curara,  seeing  the  good  results  which  had  been 
obtained  in  tetanus.  A subcutaneous  injection  of  two  centigrams 
of  curara  (about  one-third  of  a grain)  in  water  was  administered. 
This  was  about  three  hours  after  the  sudden  onset  of  the  disease. 
A quarter  of  an  hour  later,  there  having  been  no  visible  effect,  the 
dose  was  repeated,  after  which  the  condition  began  slightly  to 
improve — that  is,  there  were  longer  intervals  between  the  spasms, 
and  the  muscular  movements  became  less,  and  finally  ceased. 
This  result  induced  a continued  trial  of  the  same  treatment.  The 
injections  were  continued,  a somewhat  larger  do«e  (three  centi- 
grams) being  used.  They  were  timed  in  such  a way  that  an 
interval  sufficiently  long  between  the  doses  was  allowed  for  the 
physiological  action  of  the  drug,  and  for  any  manifestation  of  the 
curara  intoxication  to  be  obtained.  Thus,  at  twelve  o’clock  the 
third  injection  was  given,  and  the  intervals  of  spasm  became  longer. 
In  an  hour  another  injection  was  ordered,  and  the  intervals  again 
became  longer.  At  the  same  time  the  feeling  of  anxiety  and  op- 
pression was  less  intense.  A fifth  injection  was  given  at  2 a.m., 
and  a sixth  at  2.30.  The  intervals  between  the  spasms  now  ex- 
tended to  ten  minutes,  and  the  pain  in  the  chest  and  throat  was 
almost  gone.  Indeed,  there  was  a peculiar  condition  of  hilarity 
and  talkativeness,  instead  of  the  previous  anxiety.  Then  the  first 
appearances  of  loss  of  voluntary  power  just  began  to.  show  them- 


116 


HYDEOPHOBIA. 


selves.  After  one  more  injection  (the  seventh),  at  3.20,  the  spasms 
ceased  entirely,  and  symptoms  of  a general  paralysis  of  all  volun- 
tary movements  became  quickly  apparent.  The  eyelids  could  only 
be  moved  with  difficulty ; there  was  difficulty  also  in  speaking. 
Breathing  continued  normal ; only  twice  was  there  any  arrest  ot 
respiration,  and  this  was  overcome  easily  by  making  one  or  two 
rhythmical  movements  with  the  abdominal  parietes  ; the  breathing 
then  continued  regular.  After  these  toxic  effects  had  lasted  with 
this  intensity  about  two  hours,  movements  again  became  freer. 
Some  hours  after  the  last  injection  of  curara,  it  was  seen  that  the 
dread  of  water  no  longer  existed,  as  the  girl  could  drink  freely 
without  any  difficulty  whatever.  The  sensitiveness  to  light  also 
disappeared,  and,  indeed,  all  the  symptoms  of  hydrophobia  sub- 
sided. Thus  within  four  hours  and  thirty-five  minutes  seven  in- 
jections had  been  administered,  representing  altogether  nineteen 
centigrams  of  curara.  During  the  course  of  the  next  few  days 
a mixture  of  symptoms,  partly  arising  from  the  curara,  and  partly 
from  the  effects  of  the  recent  disease,  developed.  The  latter  con- 
sisted of  slight  muscular  movements,  and  involuntary  spasmodic 
respiratory  troubles,  which,  for  the  most  part,  were  produced  by 
the  irritation  of  drinking,  or  fright,  though  they  occurred  sponta- 
neously every  now  and  then.  On  the  evening  of  the  next  day  but 
one  some  of  these  symptoms  assumed  a serious  aspect,  and  another 
injection  of  curara  was  at  once  ordered,  after  the  administration  of 
which  they  disappeared.  These  symptoms,  though  of  much  less 
intensity,  continued  to  recur  until  the  eighth  day,  after  which  they 
finally  disappeared.  The  girl  was  discharged  cured  on  December 
3d  of  the  same  year,  and  went  into  service  a few  weeks  later.  She 
is  now  in  perfect  health. 

Dr.  Offenherg's  Remarks. — The  favorable  action  of  curara  in 
human  hydrophobia  may  be  explained  as  follows : The  chiet 
symptom  certainly  is  the  frequent  spasms.  These  spasms,  which 
become  more  violent  after  each  attack,  are  the  cause  of  the  con- 
stantly increasing  danger  of  the  disease,,  and  they  are  finally  the 
cause  of  death,  which  results  either  from  exhaustion  or  from  acute 
asphyxia.  Curara,  unlike  other  narcotics,  does  not  act  directly 
on  the  nerve-centres,  but  seems  to  act  rather  on  the  peripheral 
nerves.  Its  chief  action  seems  to  consist  in  paralyzing  the  motor 
nerves,  and  especially  (and  soonest)  those  of  the  voluntary  and 


TKEATMENT. 


11/ 


striped  muscles ; then,  after  large  doses,  those  of  the  involuntary 
muscles.  An  animal  to  which  large  doses  of  curara  have  been 
administered  cannot  move  about  voluntarily,  neither  can  re- 
flex movements  be  produced.  If  the  motor  nerves  or  even  the 
spinal  cord  are  irritated  by  a very  strong  electric  current  during 
the  action  of  curara,  muscular  contractions  cannot  be  produced  ; 
the  muscles  seem  to  be  cut  off  entirely  from  the  nervous  system. 
The  administration  of  curara  in  hydrophobia  is  not  new.  l^iemeyer 
seems  to  have  been  the  first  to  have  tried  it.  He  injected  in  his 
case  five  milligrams,  and  then  one  centigram,  at  intervals  of 
three  or  four  hours.  “ This  treatment  seemed  to  be  of  temporary 
service,  and  to  produce  greater  relief  than  very  large  injections  of 
morphia.”  Niemeyer  strongly  urged  a further  trial  of  this  drug 
in  larger  doses  in  other  cases  of  hydrophobia.  No  other  successful 
results  seem  to  have  been  obtained.  Gualla  has  used  curara  in 
four  cases  of  hydrophobia,  and  without  success,  but  it  is  doubtful 
whether  his  doses  were  large  enough.  Theoretical  arguments,  no 
less  than  the  above  case,  seem  to  indicate  that  the  paralyzing  effect 
of  curara  is  necessary  to  secure  success.  This  case  also  proves 
that  life  may  be  sustained  in  spite  of  general  muscular  paralysis, 
the  chief  effort  being,  of  course,  to  keep  up  respiration  by  artificial 
means.  There  is  less  danger  of  cardiac  paralysis.  It  is  a misfor- 
tune that  a definite  dose  of  curara  cannot  be  indicated,  the  doses 
variously  allowed  by  authors  ranging  from  one  milligram  to 
fifteen  centigrams.  The  difference  depends,  probably,  on  the 
quality  of  the  drug.  Another  explanation,  however,  may  be 
given.  The  action  of  curara  depends  chiefly  on  the  excitability 
of  the  nervous  system.  The  greater,  then,  the  excitation  and  the 
excitability,  and  the  greater  the  physical  exaltation,  the  more 
violent  and  intense  will  be  the  spasms,  and  the  greater,  therefore, 
must  be  the  amount  of  the  curara  to  hold  these  spasms  in  check. 
Thus,  not  only  in  different  cases,  but  also  at  different  periods  in 
the  course  of  the  same  case,  entirely  different  doses  of  the  same 
preparation  will  be  indicated.  A dose  of  curara,  such  as  in  a 
healthy  individual  with  a normal  nervous  system  would  produce 
decided  effects  on  the  motor  powers,  would  produce  scarcely  any 
effect  whatever  on  one  who  is  the  subject  of  hydrophobia.  The 
knowledge  of  this  circumstance  is  of  great  importance,  and  we 
may  commence  at  once  with  larger  doses  than  we  should  probably 


118 


HYDROPHOBIA. 


/ 


otherwise  employ  ; yet  the  difficulties  of  administering  the  drug  are 
only  partially  overcome,  especially  as  we  have  to  administer  it 
until  we  get  paralyzing  effects.  Obviously  the  safest  way,  then,  to 
administer  curara  is  to  give  small  doses,  and  to  repeat  them  at 
short  intervals,  until  the  effects  we  desire  are  brought  about ; and 
as  a subcutaneously  administered  dose  commences  to  act  in  a few 
minutes,  and  further,  as  (according  to  Demme)  the  action  of  a 
dose  of  curara  only  lasts  from  four  to  five  hours,  so  then  we  may 
most  surely  and  safely  obtain  the  effects  of  curara  by  oft  repeated 
small  injecdons.  Thus,  if  an  injection  be  practiced  every  half 
hour — a period  of  time  which  largely  suffices  in  order  to  get  the 
action,  and  the  whole  action,  of  an  injected  dose  of  curara — we 
shall  be  able  within  four  or  five  hours,  to  make  eight  or  ten  injec- 
tions. In  using  curara  in  this  manner,  we  not  only  secure  its 
physiological  action,  but  also  guard  ourselves  against  any  sudden  and 
too  energetic  manifestation  of  its  toxic  qualities.  The  action  of  small 
doses  is  proportionate,  both  in  intensity  and  duration,  and  so  soon 
as  any  dangerous  symptoms  show  themselves,  we  should  withhold 
its  further  administration,  and  take  preciutions  suitable  to  the  oc- 
casion. * * * ^ The  various  precautions  to  take,  then,  and 

the  dosage,  will  depend  on  the  individual  case,  and  must  be  left  to 
the  discretion  of  the  surgeon  in  charge. 

Oxygen. — Drs.  Schmidt  and  Zebeden^  of  Russia,  re- 
port a case  in  which  the  first  symptoms  of  hydrophobia 
appeared  seventeen  days  after  the  injury.  The  patient 
was  made  to  inhale  three  cubic  feet  of  oxygen,  and  two 
hours  afterward  he  was  in  a state  of  perfect  calm.  Two 
days  afterward  the  symptoms  of  hydrophobia  reap- 
peared, and  another  inhalation  of  oxygen  was  admin- 
istered witli  the  same  success.  This  time  the  inhalation 
was  continued  for  forty-five  minutes.  A slight  dysp- 
noea, which  persisted  after  the  disappearance  of  the 
graver  symptoms,  was  treated  for  three  weeks  by  the 
monobromide  of  camphor. 


TREATMENT. 


119 


In  the  New  York  Herald  of  April  30tli^  1879,  this 
letter  appeared : — 

To  the  Editor  of  the  Herald  : — 

The  two  recent  deaths  from  hydrophobia  in  Brooklyn  again 
illustrating  the  inability  of  medical  science  to  grapple  with  this 
fearful  disease,  it  may  be  acceptable  to  the  public  to  know  that  a 
well-authenticated  cure 'of  hydrophobia  is  stated  to  be  occupying 
some  attention  in  European  medical  circles.  The  discovery  is  due 
to  the  experiment  of  two  Russian  physicians,  Drs.  Schmidt  and 
Zebeden.  A little  girl  was  bitten  in  the  hand  by  a mad  dog.  The 
wound,  after  being  cauterized,  healed  in  a few  days,  but  a fortnight 
after  the  symptoms  of  hydrophobia  set  in.  The  physicians  there- 
upon made  the  little  patient  inhale  three  cubic  feet  of  oxygen.  By 
this  means,  in  the  course  of  an  hour  and  a half,  all  the  symptoms 
disappeared,  and  the  child  remained  calm.  On  the  next  day  but 
one  the  malady  returned  in  all  its  distressing  characteristics,  diffi- 
culty of  breathing  and  swallowing,  and  tonic  convulsions.  A fresh 
inhalation  of  oxygen  was  tried,  and  at  the  end  of  forty-five  min- 
utes the  attack  subsided  and  never  returned.  The  above  informa- 
tion comes  by  way  of  Paris,  the  particulars  of  the  case  being  given 
almost  in  the  words  above  recorded.  Here  is  a remedy,  perfectly 
simple,  and  obtainable  with  ease  in  New  York,  and  I think  it 
would  be  prudent  if  the  physicians,  in  the  next  case,  at  least,  put 
it  to  the  test.  J.  M. 

This  is  the  sum  of  the  literature  of  oxygen  in  the 
treatment  of  hydrophobia.  It  is  the  most  recent  ad- 
vance in  therapeutics,  and  if  it  be  true,  as  I hold  it  to 
be,  that  the  primary  disturbance  is  due  to  a ferment 
which  inhibits  the  proper  function  of  the  red  corpuscles, 
then  the  employment  of  oxygen  would  be  most  rational. 
So  far  from  being  convinced  that  the  nervous  manifest- 
ations of  hydrophobia  are  primary,  and  that  to  their 
correction  our  remedial  agencies  should  be  directed,  I 
would  rather  seek  in  the  blood  the  cause  engendering 

c?  O 


120 


HYDROPHOBIA. 


such  symptoms  of  nervous  derangement,  and  treat  them 
as  intercurrent  and  secondary  disorders. 

Turkish  Baths, — Sir  Thomas  Watson,  in  his  Pracfice 
of  Physic,  sums  up  his  treatment  of  hydrophobia  as  fol- 
lows: ‘^And  with  respect  to  the  established  disease,  I 
think  that  if  I were  the  unhappy  subject  of  it,  I should 
wish  to  be  put  into  a hot  air  bath  and  thoroughly 
sweated,  and  to  take  opiates ; not  so  much  in  the  hope 
of  recovering,  as  with  a view  to  the  euthanasia.^^  Flem- 
ing writes:  ‘^Hot  water  or  vapor  baths  should  more 
particularly  be  resorted  to  during  the  incubatory  period, 
as  they  are  likely  to  increase  the  excitement,  dyspnoea, 
and  cerebro-spinal  congestion,  when  the  malady  has 
actually  declared  itself  or  made  some  progress.^^  The 
Turkish  bath  is  not  a preservative,  per  se,  but  is  a most 
useful  supplemental  agent  and  adjunct  to  the  mental 
treatment.  By  acting  u[)on  the  pores  and  rendering 
more  active  the  function  of  the  skin,  it  serves  to  elimi- 
nate deleterious  matters  from  the  blood,  and  imparts 
general  tonicity  to  the  system.  That  it  has  been  vaunted 
as  a panacea  for  all  diseases,  and  that  its  use  has  been 
much  abused  by  charlatanism,  should  not  militate 
against  its  proper  employment  by  the  intellectual  prac- 
titioner. The  abuse  of  any  remedy  should  not  contra- 
indicate its  legitimate  use.  Dr.  Buisson  asserts  that  he 
not  only  cured  himself,  but  also  eighty  patients  who 
had  been  bitten  by  rabid  animals ; but  as  hydrophobia 
may  not  necessarily  develop  after  the  bite  of  a rabid 
animal,  and  as  other  observers  have  failed  to  derive  any 
benefit  from  the  use  of  the  Turkish  bath,  his  evidence 
is  not  satisfactory.  As  an  auxiliary,  it  is  extremely 


TREATMENT. 


121 


valuable.  It  soothes  the  nervous  system,  relieves  the 
respiratory  organs,  cleanses  the  skin  and  imparts  healthy 
action  to  the  kidneys. 

General  Treatment. — Bouley  says : He  is  convinced 
that  the  practices  or  medications,  whatever  they  may  be, 
which  address  themselves  to  the  morale  of  those  who 
are  the  victims  of  rabaic  inoculations  may  prove  very 
useful,  and  that  he  has  caused  persons  who  were  labor- 
ing under  the  dread  of  hydrophobia  to  take  some  inno- 
cent beverage  as  an  infallible  specific.^^  He  adds: 
^^The  memories  I entertain  of  the  immense  content- 
ment it  has  produced  have  always  confirmed  me  in  the 
belief  that  it  is  not  good  to  destroy  such  illusions  and 
belief,  but,  on  the  contrary,  to  create  them.^^ 

The  influence  of  miind  upon  body  is  such  a powerful 
and  well-recognized  factor  at  this  time,  in  the  treatment 
of  any  disease,  that  no  one  would  be  accused  of  charla- 
tanism who  ordered  his  patient  a placebo,  and  by  work- 
ing upon  the  imagination  established  that  faith  in  its 
efficacy  which  would  induce  mental  quietude.  The 
sight  of  a physician  is  oftentimes  of  benefit  to  the  pa- 
tient; hence  the  practitioner  should  use  his  moral  power 
and  influence,  and  so  gain  the  confidence  of  the  sufferer 
as  to  establish  a feeling  of  security.  If  sleep  be  dis- 
turbed, we  may  legitimately  employ  chloral  hydrate  or 
subcutaneous  injections  of  morphia.  And  lastly,  we 
should  bear  in  mind  an  important  matter  mentioned  by 
Fleming : — 

If  a person  has  been  bitten  by  a dog,  or  if  animals  have  been 
wounded  by  it,  and  the  creature  at  the  time  does  not  exhibit  any 
distinct  signs  of  rabies,  it  is  well,  to  tranquillize  the  minds  of  those 


122 


HYDROPHOBIA. 


chiefly  concerned,  and  who  are  apprehensive  of  danger,  to  secure 
it  properly  for  a number  of  days,  say  a fortnight  or  three  weeks, 
before  allowing  it  to  go  at  large  again.  If  it  was  really  rabid  when 
it  inflicted  the  injury,  it  will  soon  exhibit  unmistakable  signs  of 
disease  and  die ; or  it  may  then  be  killed,  and  every  precaution 
taken  accordingly.  If  the  above  mentioned  period  passes  without 
any  manifestation  of  rabies,  then  the  possibility  of  future  disaster 
ensuing  from  the  wound  is  happily  disposed  of,  and  great  anxiety 
abolished.  But  if  the  dog  is  destroyed  without  any  evidence  that 
it  was  suffering  from  the  disease,  then  months  of  the  most  painful 
suspense,  and  even  anguish,  may  perhaps  elapse  before  the  result 
can  be  known.  In  these  circumstances  all  that  can  be  done  is 
carefully  to  inquire  into  the  aggressive  animal’s  history,  ascertain 
all  the  symptoms  exhibited  by  it,  and  its  behavior  immediately 
before  and  after  inflicting  the  wound.” 

M.  Desjardiiie,  recognizing  the  value  of  this  measure, 
says  that  as  soon  as  a person  has  been  bitten  by  a sus- 
pected animal,  we  should  hasten  to  secure  it,  so  that  it 
can  do  no  more  damage,  and  watch  it  closely,  instead  of 
killing  it  at  once,  as  is  the  custom.  Give  it  several 
drops  of  syrup  of  buckthorn,  and  afterwards  a dose  of 
phosphorus,  15  centigrams,  reduced  to  powder,  and 
mixed  in  sufficient  quantity  of  water.  If  the  animal 
lives,  its  healthy  condition  should  be  made  known  to 
the  person,  for  the  mind  exercises  so  great  an  influence 
that  it  seems  at  times  and  in  certain  conditions,  accord- 
ing to  the  idiosyncrasy  of  the  individual,  to  constitute 
the  sole  and  unique  cause  of  this  terrible  affection.  But 
if,  on  the  contrary,  the  dog  dies,  its  death  must  be  care- 
fully concealed,  or  another  must  be  substituted,  in  order 
to  make  the  person  believe  that  the  animal  was  healthy, 
and  that  the  treatment  to  which  he  was  submitted  was 
merely  adopted  to  dispel  the  fear  and  alarm  he  experi- 
enced on  receipt  of  the  injury. 


TREATMENT. 


123 


CHAPTER  VIII. 

TREATMENT  CONTINUED, 

Preventive. — -The  following  resumS  of  preventive 
measures  is  taken  from  Dr.  Dolan  : — 

A.  The  owners  of  dogs  and  other  animals  should  be  made  to 
understand  the  responsibility  that  rests  upon  them  with  regard  to 
the  health  of  their  animals,  particularly  when  contagious  diseases 
appear  among  them. 

B.  The  number  of  useless  dogs  should  be  diminished  as  much 
as  possible,  and  a tax  should  be  levied  on  all  dogs. 

C.  Every  dog  should  wear  a collar,  with  owner’s  name  and 
address  engraved  thereon,  as  well  as  a particular  mark  impressed 
by  the  licensing  or  police  authorities  ; for  the  proper  registration 
and  identification  of  the  animal. 

D.  All  stray  dogs  without  the  collar  or  the  owner’s  name  and 
address,  should  be  captured,  and,  if  not  claimed  within  a limited 
period,  sold  or  destroyed  ; and  dogs  straying  with  the  proper  collar 
on  may,  when  circumstances  render  it  necessary,  be  seized  and 
confined  or  returned  to  the  owner,  who  pays  expenses  and  is  fined, 
if  need  be.  Bitches  in  rut  should  not  be  allowed  to  go  at  large  at 
any  time. 

E.  Unless  under  special  circumstances,  as  when  rabies  is  prev- 
alent, or  when  certain  animals  are  vicious,  the  muzzle  should  not 
be  worn. 

F.  The  owners  of  dogs  should  be  held  responsible  for  the  dam- 
age done  by  them. 

G.  Diseased  dogs,  or  those  which  show  the  slightest  symptoms 
of  disease,  altered  habits,  etc.,  should  be  carefully  watched,  and 
precautions  adopted.  If  the  symptoms  of  rabies  appear,  the  cir- 
cumstances should  be  reported  to  the  police  by  the  owner  or 
attendant  on  the  dog,  or  other  persons  who  know  of  its  condition. 
Neglect  of  this  should  be  estimated  as  a criminal  offence.  The 
police  should  know  the  early  symptoms  of  the  disease, 


124 


HYDROPHOBIA. 


H.  If  other  animals  which  have  been  in  contact  with  or  bitten 
by  a rabid  dog,  become  unwell  afterwards,  the  symptoms  ought  to 
be  noticed,  and  should  they  lead  to  a suspicion  of  rabies,  the  crea- 
tures must  be  isolated  and  their  condition  reported  to  the  police. 

I.  Suspected  animals  should  not  be  killed  at  once,  if  they  have 
bitten  any  person,  but  only  destroyed  when  the  disease  is  unmis- 
takably present. 

J.  A mad  or  suspected  dog  escaping  from  its  owner,  or  appear- 
ing in  a district,  should  be  the  signal  of  alertness,  and  those  who 
know  of  the  circumstances  ought  to  warn  the  police  at  once. 
Children  should  be  guarded  and  animals  confined  or  kept  from 
strange  dogs.  All  wandering  dogs  should  be  confined  or  killed. 

K.  Rabid  dogs  should  be  killed,  or,  if  suspected,  they  may  be 
kept  until  their  condition  is  ascertained. 

L.  The  police  authorities  should  endeavor  to  obtain  every 
information  about  any  rabid  or  suspected  dog,  and  to  discover 
the  name  and  address  of  .its  owner ; learning  also  what  damage  it 
may  have  done.  Regulations  and  restrictions  should  be  extended 
over  a wide  space  of  country,  and  neighboring  districts  should  be 
warned.  All  information  necessary  to  put  the  inhabitants  on  the 
alert  ought  also  to  be  given. 

M.  When  the  disease  appears  in  a virulent  or  epizootic  form,  all 
measures  ought  to  be  vigorously  enforced,  Owners  of  dogs  should 
give  due  notice  of  all  changes  occurring  among  their  animals. 
Muzzling  may  be  necessary,  but  the  muzzle  for  each  dog  should  be 
properly  and  securely  constructed,  and  sufficient  in  size  without 
being  too  large.  It  must  have  appliances  for  attaching  it  firmly  to 
the  head. 

N.  The  destruction  and  confinement  of  dogs  must  be  assiduously 
carried  out,  and  heavy  fines  or  imprisonment  should  be  imposed 
upon  those  who  attempt  to  evade  or  neglect  the  regulations. 

O.  Dogs  should  be  slaughtered  with  as  little  cruelty  as  possible. 
They  ought  to  be  buried  deeply  in  the  ground. 

P.  Disinfection  should  be  carried  out  as  with  other  contagious 
diseases. 

Q.  The  police  regulations  and  restrictions  should  be  continued 
for  some  months  beyond  the  appearance  of  the  last  case  of  rabies. 
This  period  should  be  dependent  on  the  limit  of  the  incubatory 
stage  of  the  disease  in  the  dog. 


TREATMENT. 


125 


R.  With  regard  to  other  animals,  when  wounded  by  a suspected 
or  rabid  dog,  the  circumstance  should  be  reported,  and  steps  taken 
to  insure  safety.  Horses,  oxen  and  other  working  animals  may 
be  employed  in  the  immediate  vicinity  of  their  homes,  but  must 
not  be  sold,  bartered  or  removed  within  a certain  period.  The 
immediate  slaughter  of  wounded  or  suspected  animals  is  not  neces- 
sary, but  as  soon  as  rabies  manifests  itself  notice  should  be  given 
to  the  local  authorities,  and  the  necessary  steps  taken  to  prevent 
damage.  The  bodies  should  be  buried  intact,  though,  under  spe- 
cial circumstances,  skinning  them  may  be  allowed,  in  order  to  tan 
or  dress  these  parts. 

S.  Disinfection  to  be  resorted  to,  as  in  the  case  of  rabid  dogs. 

T.  The  flesh  is  not  dangerous  as  food  until  the  symptoms  of  the 
disease  have  appeared.  If  used  before  this  period,  certain  pre- 
cautions should  be  adopted. 

V.  The  milk  may  also  be  utilized  during  the  same  period. 

X.  Competent  veterinarians  must  cooperate  in  the  execution 
of  these  measures. 

From  the  Gesetz  betreffend  die  Abwehr  und  Unter- 
drilekung,  vom  25  June,  1875,  etc.,  etc.,  Berlin,  1877, 
kindly  furnished  me  by  Mr.  Kreisman,  Consul-General 
at  Berlin,  I translate  as  follows  : — 

HYDROPHOBIA  OF  DOMESTIC  AXIMALS — PRESERVATIVE. 

106.  Dogs, — Dogs  which  have  rabies,  or  show  signs  of  it,  must 
be  killed  immediately,  or  safely  secured  until  the  arrival  of  the 
police  or  owner.  If  people  have  already  been  bitten  by  such  an 
animal,  or  if  in  any  way  such  people  have  come  in  contact  with  a 
rabid  dog,  the  suspicion  of  infection  being  well  founded,  the  dog 
should  not  be  killed  until  the  arrival  of  the  police,  but  should  be 
locked  up,  if  this  can  be  done  without  danger. 

107.  The  transportation  of  a dog  suspected  to  be  rabid  must  be 
done  in  a close  conveyance,  or,  after  muzzling  him,  by  leading 
him  with  a chain  ; if  he  cannot  be  muzzled,  he  must  be  led  by  two 
chains,  between  two  men. 

108.  The  police  court  of  the  precinct  must  see  to  it  that  the  dogs 
which  have  been  locked  up  are  examined  immediately  by  an  offi- 


126 


HYDROPHOBIA. 


cial,  or,  if  it  should  take  long  to  send  for  him,  any  other  approved 
veterinary  surgeon  may  examine  the  dog.  If  the  opinion  of  the 
surgeon  should  leave  it  in  doubt  whether  the  dog  has  been  sub- 
jected to  the  infection  from  another  dog,  known  to  be  “ mad,”  he 
should  be  locked  up  for  six  days,  and  if  at  the  expiration  of  this 
time  he  should  be  still  alive,  he  is  to  be  set  free. 

109.  If  a dog  who  is  suspected  to  be  rabid  should  be  killed,  or  if 
he  should  die  during  his  isolation,  he  should  be  dissected  by  the 
veterinary,  upon  order  of  the  police  court,  to  ascertain  if  man  or 
beast  could  have  contracted  the  disease  from  him  while  he  was 
running  about. 

110.  If  the  existence  of  rabies  has  been  established  by  the 
modes  prescribed  in  ^ 11  and  | 12  of  the  law,  the  police  court 
must  publicly  announce  the  outbreak  of  the  disease  in  the  news- 
papers which  are  selected  for  the  purposes  of  the  court. 

111.  According  to  § 49  of  the  law,  rabid  dogs  must  be  killed 
immediately.  The  police  court  must  also  order  to  be  killed  all 
those  dogs  which  are  suspected  to  have  been  bitten  by  a rabid 
dog,  or  in  whom  the  suspicion  of  infection  may  be  looked  upon  as 
proven. 

112.  If  a dog  be  rabid,  or,  if  suspected  of  being  so,  has  been 
running  about  without  being  muzzled,  the  police  court  must  order 
all  dogs  in  the  place  to  be  chained  [|  50  of  the  law].  Every  town 
must  be  regarded  as  exposed  to  danger,  in  which  rabid  dogs  or 
suspicious  dogs  are  seen.  All  places  within  four  kilometers  of  the 
place  must  also  be  looked  upon  as  dangerous.  If  the  suspicion  of 
rabies  be  groundless,  the  order  for  chaining  the  dogs  must  be 
revoked  ; but  if  the  existence  of  the  disease  is  proven,  they  must 
be  chained  up  for  at  least  three  months.  The  police  can  order  all 
dogs  running  about  the  streets,  supposed  to  be  rabid,  to  be  killed 
at  once,  regardless  of  the  court’s  order.  In  towns  in  which  dogs 
are  muzzled  this  order  need  not  be  enforced.  This  order  is  not 
intended  to  apply  to  dogs  which  are  used  for  pulling  carts,  if  they 
are  harnessed  securely  to  the  cart  and  are  muzzled.  Shepherds’ 
dogs  are  also  exempt. 

As  long  as  the  disease  is  not  of  great  extent,  hunting  dogs,  em- 
ployed for  hunting  purposes,  if  they  are  securely  muzzled  when 
not  upon  the  hunting  grounds,  or  if  they  are  led  by  a cord. 


TREATMENT. 


127 


2.  Cats, — 313.  The  rules  in  | 100-111  will  apply  to  cats  which 
show  signs  of  madness,  with  the  necessary  modifications. 

314.  Other  domestic  animals  which  are  bitten  by  a rabid  animal, 
or  by  one  who  has  been  in  the  neighborhood  of  a rabid  animal,  in 
whom  the  suspicion  of  infection  is  proven,  must  be  put  under 
police  observation,  during  the  dangerous  period,  provided  that  the 
owner  dpes  not  wish  him  to  be  killed. 

115.  For  horses,  the  period  of  danger  is  supposed  to  be  three 
months;  for  cattle,  four  months;  for  sheep,  goats  or  swine,  two 
months. 

116.  As  long  as  the  animals  are  proved  by  the  inspection  of  the 
veterinary  to  be  free  from  the  disease,  they  may  be  employed  for 
labor.  If  they  show  changes  which  prove  them  to  be  rabid,  the 
owner  is  compelled  to  notify  the  police  court  immediately.  The 
court  will  summon  the  veterinary,  and  if  the  animals  are  shown  to 
be  rabid,  they  must  be  locked  np  in  the  stable. 

, 117.  If  rabies  be  proved,  the  animal  must  be  killed  imme- 
diately. 

118.  No  curative  means ' shall  be  employed  upon  any  anima‘1 
supposed  to  be  rabid,  before  the  arrival  of  the  police. 

119.  It  is  forbidden  to  slaughter  or  to  skin  any  rabid  animal,  or 
sell  any  part  or  production  of  the  same. 

120.  The  bodies  of  any  rabid  animals  who  may  have  been  killed 
are  to  be  burned  by  chemicals,  or  to  be  buried,  after  cutting  off 
the  skin.  The  use  of  any  part  is  forbidden.  The  authorized 
veterinary  surgeon  is  the  only  one  permitted  to  dissect  the  body. 
The  police  court  must  designate  a place  for  the  burial  of  such 
bodies. 

121.  Wooden  utensils,  kennels  and  stewpans  used  for  dogs, 
must  be  burned.  Stable  utensils  used  for  other  domestic  animals 
must  be  cleansed  with  soap-lye  or  with  boiling  water ; iron  arti- 
cles must  be  made  over.  Stables  must  be  cleaned,  and  the  walls 
and  floors  disinfected  with  the  chlorate  of  lime. 

122.  In  regard  to  rabid  animals  which  are  delivered  to  Royal 
medical  colleges,  or  kept  in  the  animal  hospitals,  or  any  high  col- 
lege, the  22d  paragraph  of  the  law  must  be  observed. 

Tlie  following  regulation  exists  in  London.  It  forms 
part  of  An  act  for  regulating  the  Traffic  in  the  Me- 


128 


HYDROPHOBIA. 


tropolis,  and  for  making  provision  for  the  greater  secu- 
rity of  persons  passing  through  the  streets^  and  for  other 
purposes/^  [20th  August,  1867,  30  and  31  Viet.,  chap. 
134.] 

^‘Police  may  take  possession  of  any  dog  found  in  any  street  within 
the  metropolis,  and  not  under  the  control  of  any  person,  and  may 
detain  such  dog  until  the  owner  has  claimed  the  same  and  paid  all 
expenses  incurred  by  reason  of  such  detention.  The  Commis- 
sioner of  Police,  if  he  see  fit,  may  issue  a notice  requiring  any  dog, 
while  in  the  streets,  and  not  Jed  by  some  person,  to  be  muzzled  in 
such  a manner  as  will  admit  of  the  animal  breathing  and  drinking 
without  obstruction  ; and  the  police  may  take  possession  of  any 
dog  found  loose  in  the  streets  and  without  such  muzzle,  during  the 
currency  of  the  order,  and  may  detain  such  dog  until  the  owner 
has  claimed  it,  has  provided  a proper  muzzle  and  has  paid  all  ex- 
penses connected  with  such  detention.  Where  any  dog,  taken 
possession  of  by  the  police,  wears  a collar  with  the  address  of  any 
person  inscribed  thereon,  a letter,  stating  the  fact  of  such  dog 
having  been  taken  possession  of,  shall  be  sent  by  post  to  the 
address  inscribed  on  the  collar.  The  Commissioner  of  Police 
may  cause  any  dog  which  has  remained  in  the  possession  of  the 
police  for  three  clear  days  without  the  owner  claiming  the  same, 
and  paying  all  expenses  incurred  by  its  detention,  to  be  sold  or 
destroyed.  Any  moneys  arising  from  the  sale  of  any  dogs  in  pur- 
suance of  this  section  shall  be  applied  in  the  manner  in  which 
penalties  under  this  act  are  applicable.  When,  upon  complaint 
that  any  dog  has  bitten  or  attempted  to  bite  any  person  within  the 
metropolis,  it  appears  to  magistrates  having  cognizance  of  such 
complaint  that  any  such  dog  ought  to  be  destroyed,  the  magistrate 
may  direct  the  dog  to  be  destroyed,  and  any  police  constable  may 
destroy  the  same  accordingly;  and  all  dogs  detained  by  the  police 
under  this  section  shall  be  properly  fed  and  maintained.’^ 

The  New  English  Dog  Act,  published  on  the  24th 
of  July,  1871,  and  entitled  An  act  to  provide  further 
protection  against  dogs,^’  is  applicable  to  the  whole  of 
Great  Britain.  It  is  as  follows  : — 


TREATMENT. 


129 


Whereas,  it  is  expedient  that  further  protection  should  be  pro- 
vided against  dogs : 

‘‘Be  it  enacted  by  the  Queen’s  most  excellent  Majesty,  by  and 
with  the  advice  and  consent  of  the  Lords,  spiritual  and  temporal, 
and  Commons,  in  this  present  Parliament  assembled,  and  by  the 
authority  of  the  same,  as  follows  : — 

“1.  From  and  after  the  passing  of  this  Act  any  police  officer  or 
constable  may  take  possession  of  any  dog  that  he  has  reason  to 
suppose  to  be  savage  or  dangerous,  straying  on  any  highway  and 
not  under  the  control  of  any  person,  and  niay  detain  such  dog 
until  the  owner  has  claimed  the  same  and  paid  all  expenses  incurred 
by  reason  of  such  detention. 

“Where  the  owner  of  any  dog  taken  possession  of  by  any  con- 
stable is  known,  a letter,  stating  the  fact  of  such  dog  having  been 
taken  possession  of,  shall  be  sent  by  post  or  otherwise,  to  the 
owner  at  his  usual  or  last  known  place  of  abode.  When  any  dog 
taken  in  pursuance  of  this  Act  has  been  detained  for  three  clear 
days,  where  the  owner  is  not  known,  as  aforesaid,  or  for  five  clear 
days  where  he  is  so  known,  without  the  owner  claiming  the  same 
and  paying  all  expenses  incurred  by  its  detention,  the  chief  officer 
of  police  of  the  district  in  which  such  dog  was  found  may  cause 
such  dog  to  be  sold  or  destroyed. 

“ Any  moneys  arising  from  the  sale  of  any  dogs,  in  pursuance  of 
this  section,  shall  be  paid  to  the  account  of  the  local  rate,  and  be 
applied  to  the  purposes  to  which  that  rate  is  applicable. 

“ All  dogs  detained  under  this  section  shall  be  properly  fed  and 
maintained  at  the  expense  of  the  local  rate. 

‘ ‘ 2.  Any  Court  of  Summary  Jurisdiction  may  take  cognizance  of  a 
complaint  that  a dog  is  dangerous  and  not  kept  under  proper  control, 
and  if  it  appears  to  the  Court  having  cognizance  of  such  complaint 
that  such  dog  is  dangerous,  the  Court  may  make  an  order,  in  a 
summary  way,  directing  the  dog  to  be  kept  by  the  owner  under 
proper  control  or  destroyed ; and  any  person  failing  to  comply  with 
such  order  shall  be  liable  to  a penalty  not  exceeding  twenty  shillings 
for  every  day  during  which  he  fails  to  comply  with  such  order. 

“ 3.  The  local  authorities  may,  if  a mad  dog,  or  a dog  suspected 
of  being  mad,  is  found  within  their  jurisdiction,  make,  and  when 
made,  vary  or  revoke,  an  order  placing  such  restrictions  as  they 
may  think  expedient  on  all  dogs  not  under  the  control  of  any  per- 


130 


HYDEOPHOBIA. 


son  during  such  period  as  maybe  prescribed  in  such  order,  through- 
out the  whole  of  their  jurisdiction,  or  such  part  thereof  as  may  be 
prescribed  in  such  order. 

^‘Any  person  who  acts  in  contravention  of  any  order  made  in  pur- 
suance of  this  section  shall  be  liable  to  a penalty  not  exceeding 
twenty  shillings. 

Due  notice  of  such  order  shall  be  published,  at  the  expense  of 
the  local  rate. 

The  provisions  of  this  Act  contained  as  to  the  detention  and  sale 
or  destruction  of  dogs  found  straying  on  the  highway  shall  apply  to 
dogs  found  at  large  in  contravention  of  any  order  made  in  pursuance 
of  this  section. 

‘^4.  In  England  and  Ireland  any  penalty  under  this  Act  may  be 
recovered  in  manner  provided  by  the  Summary  Jurisdiction  Act, 
and  in  Scotland  all  such  penalties  shall  be  prosecuted  and  recov- 
ered before  a Court  of  Summary  Jurisdiction,  under  the  provisions 
of  the  Summary  Jurisdiction  Act,  1864.” 

Max  Da  Camp  (jEri  Hollande,  Paris,  1859),  states : 

At  Harlingen,  in  Friesland,  I saw  a dog  pass  which 
had  a wooden  cross  hanging  at  its  neck  ; then  a second 
dog  and  a third ; and  finally  I observed  that  every  dog 
in  the  town  Avas  decorated  with  a similar  ornament. 
Making  inquiry  respecting  this  matter,  I was  informed 
that  all  dogs  not  Avearing  the  cross  Avere,  in  the  canton 
of  Harlingen,  immediately  apprehended  and  led  by  the 
ears  to  the  pound ; for  the  crosses  are  issued  by  the 
municipality,  and  their  possession  proves  that  the  tax 
imposed  upon  such  animals  has  been  paid.^^ 

The  Austrian  Penal  Code  (387)  says  : — 

Whoever  knows  of  a dog  or  any  other  animal  showing  the  dis- 
tinctive symptoms,  or  symptoms  which  warrant  suspicion,  of  rabies, 
and  who  neglects  to  report  the  same  to  the  police,  is  guilty  of  in- 
fraction of  the  law  and  liable  to  imprisonment.  In  case  of  the 
appearance  of  the  disease,  and  the  biting  of  men  or  of  animals,  the 
culprit  shall  be  punished  with  from  three  days’  to  three  months’ 


TREATMENT. 


131 


imprisonment  {carcere  duro).  If  a serious  wound  or  the  death  of 
a human  being  has  been  the  consequence  of  this  negligence,  the 
infraction  shall  come  under  the  application  of  835,  which  says  : 

‘ He  who  shall  be  guilty  of  this  negligence  shall  be  punished  with 
from  one  to  six  months’  imprisonment,  if  its  consequence  has  been 
a serious  wound ; if  the  death  of  a man  has  been  the  consequence, 
the  penalty  is  from  six  months’  to  a year’s  close  imprisonment. 
Otherwise,  the  proprietor  is  always  responsible  for  the  damage 
caused  by  mad  animals.’ ” 

The  same  Code  (871)  says:  “ Every  owner  of  an  animal,  no 
matter  to  what  species  it  may  belong,  which  he  knows  to  be 
vicious,  ought,  in  or  out  of  doors,  to  watch  and  take  care  of  it,  so 
that  it  may  not  wound  any  one.  Any  damage  caused  by  the  neglect 
of  this  precuation  is  punishable  by  a fine  of  from  five  to  twenty- 
five  florins,  if  there  has  been  no  wound  inflicted  ; but  when  this  is 
the  case,  the  penalty  maybe  increased  to  from  ten  to  fifty  florins.” 

The  French  Civil  Code  ordains  that  ‘‘  the  proprietor  of  an  ani- 
mal, or  he  who  employs  it,  while  it  is  in  his  employment,  is  re- 
sponsible for  the  damage  that  it  causes,  either  while  in  his  charge 
or  when  it  is  straying  or  escaped.” 


132 


HYDROPHOBIA. 


CHAPTER  IX. 

HOW  TO  RECOGNIZE  A ^^MAd’^  DOG.  EMERGENCIES, 
AND  HOW  TO  TREAT  THEM. 

assume  of  the  Symptoms  in  the  Dog,^ — As  it  is  most 
important  that  the  symptoms  of  rabies  in  the  dog  should 
be  remembered,  the  following  resumS  of  the  most  not- 
able are  given,  for  the  guidance  of  those  who  keep  dogs, 
or  who  may  have  more  or  less  to  do  with  them.  Medi- 
cal men  might  usefully  bear  the  details  in  memory,  and 
educate  the  public  in  respect  to  them  — 

1.  The  disease  is  not  characterized  by  fits  of  fury  at 
its  commencement,  but  is,  on  the  contrary,  to  all  appear- 
ances, a benignant  malady,  though  even  then  the  saliva 
or  foam  is  virulent  and  poisonous.  The  dog  is  at  this 
period  very  dangerous,  by  its  licking  rather  than  biting, 
for  as  yet  it  has  no  tendency  to  use  its  teeth. 

2.  At  the  commencement  of  the  disease  the  animaFs 
temper  becomes  changed.  It  is  dull, gloomy  and  silent; 
seeks  solitude  and  withdraws  into  the  most  obscure  cor- 
ners. But  it  cannot  rest  long  in  one  place ; it  is  fidgety 
and  agitated ; goes  here  and  there ; lies  down  and  gets 
up ; prowls  about,  smells,  and  scratches  with  its  fore- 
paws. Its  movements,  attitudes  and  gestures,  at  times, 
would  indicate  that  it  is  haunted  by  and  sees  phantoms ; 
it  snaps  at  the  air,  and  barks  as  if  attacked  by  real 
enemies. 

3.  Its  appearance  is  altered;  it  has  a gloomy  and 
somewhat  ferocious  aspect. 

* Dr.  Dolan. 


TBEATMENT. 


133 


4.  In  this  condition^  however,  it  is  not  aggressive,  so 
far  as  mankind  is  concerned,  but  is  as  docile  and  obe- 
dient to  its  master  as  before.  It  may  even  appear  to  be 
more  affectionate  towards  those  it  knows,  and  this  it 
manifests  by  a greater  desire  to  lick  their  hands  and 
faces. 

5.  This  affection,  which  is  always  so  marked  and  so 
enduring  in  the  dog,  dominates  it  so  strongly  in  rabies 
that  it  will  not  injure  those  it  loves,  even  in  a paroxysm 
of  madness;  and  even  when  its  ferocious  instincts  are 
beginning  to  be  manifested  and  to  gain  the  supremacy 
over  it,  it  will  yet  yield  obedience  to  those  to  whom  it 
has  been  accustomed. 

6.  The  mad  dog  has  not  a dread  of  water,  but,  on 
the  contrary,  will  greedily  swallow  it.  As  long  as  it 
can  drink,  it  will  satisfy  its  ever-ardent  thirst;  even 
when  the  spasms  in  the  throat  prevent  it  swallowing,  it 
will  nevertheless  plunge  its  face  deeply  into  the  water 
and  appear  to  gulp  at  it.  The  dog  is  not,  therefore, 
hydrophobic,  and  hydrophobia  is  not  a sign  of  madness 
in  this  animal. 

7.  It  does  not  generally  refuse  food  in  the  early  part 
of  the  disease,  but  sometimes  eats  with  more  voracity 
than  formerly. 

S.  When  the  desire  to  bite,  which  is  one  of  the  essen- 
tial characters  of  rabies  at  a certain  stage,  begins  to 
manifest  itself,  the  animal  at  first  attacks  inert  bodies — 
gnawing  wood,  leather,  its  chain,  carpets,  straw,  hair, 
coal,  earth,  the  excrement  of  other  animals,  or  even  its 
own;  and  accumulates  in  its  stomach  the  remains  of  all 
the  substances  it  has  been  tearing  with  its  teeth. 


134 


HYDROPHOBIA. 


9.  An  abundance  of  saliva  is  not  a constant  symptom 
of  rabies  in  the  dog.  Sometimes  its  mouth  is  humid, 
and  sometimes  it  is  dry.  Before  a fit  of  madness,  tlie 
secretion  of  saliva  is  normal ; during  this  period  it  may 
be  increased,  but  towards  the  end  of  the  malady  it  is 
usually  decreased. 

10.  The  animal  often  expresses  a sensation  of  incon- 
venience or  pain  during  the  spasm  in  its  throat,  by 
using  its  paws  on  the  side  of  its  mouth,  like  a dog 
which  has  a bone  lodged  there. 

11.  In  dumb  madness  the  lower  jaw  is  paralyzed  and 
drops,  leaving  the  mouth  open  and  dry,  and  its  lining 
membrane  exhibiting  a reddish-brown  hue ; the  tongue 
is  frequently  brown  or  blue  colored;  one  or  both  eyes 
squint,  and  the  creature  is  ordinarily  helpless  and  not 
aggressive. 

12.  In  some  instances  the  rabid  dog  vomits  a choco- 
late or  blood-colored  fluid. 

13.  The  voice  is  always  changed  in  tone,  and  the 
animal  howls  or  barks  in  quite  a different  fashion  to 
what  it  did  in  health.  The  sound  is  husky  and  jerk- 
ing. In  ^^dumb^^  madness,  however,  this  very  import- 
ant symptom  is  absent. 

14.  The  sensibility  of  the  rabid  dog  is  greatly 
blunted.  When  it  is  struck,  burned  or  wounded,  it 
emits  no  cry  of  pain  or  sign  as  when  it  suffers  or  is 
afraid  in  health.  It  will  even  sometimes  wound  itself 
severely  with  its  teeth,  and  without  attempting  to  hurt 
any  person  it  knows. 

15.  The  mad  dog  is  always  very  much  enraged  at  the 
sight  of  an  animal  of  its  own  species.  Even  when  the 


135 


HOW  TO  EECOGNIZE  A DOG. 

malady  might  be  considered  as  yet  in  a latent  condition, 
as  soon  as  it  sees  another  dog  it  shows  this  strange  antip- 
athy, and  appears  desirous  of  attacking  it.  This  is  a 
most  important  indication. 

16.  It  often  flies  from  home  when  the  ferocious  in- 
stincts commence  to  gain  an  ascendancy,  and  after  one, 
two  or  three  days’  wandering,  during  which  it  has  tried 
to  gratify  its  mad  fancies  on  all  the  living  creatures  it 
encountered,  it  often  returns  to  its  master  to  die.  At 
other  times,  it  escapes  in  the  night,  and  after  doing  as 
much  damage  as  its  violence  prompts  it  to  do,  it  will 
return  again  towards  morning.  The  distances  a mad 
dog  will  travel,  even  in  a short  period,  are  sometimes 
very  great. 

17.  The  furious  period  of  rabies  is  cliaracterized  by 
an  expression  of  ferocity  in  the  animal’s  physiognomy, 
and  by  the  desire  to  bite  whenever  an  opportunity 
offers.  It  always  prefers  to  attack  another  dog,  though 
other  animals  are  also  victims. 

18.  The  paroxysms  of  fury  are  succeeded  by  periods 
of  com[)arative  calm,  during  which  the  appearance  of 
the  creature  is  liable  to  mislead  the  uninitiated  as  to  the 
nature  of  the  malady. 

19.  The  mad  dog  usually  attacks  other  creatures 
rather  than  man,  when  at  liberty.  When  exhausted  by 
the  paroxysms  and  contentions  it  has  experienced,  it 
runs  in  an  unsteady  manner,  its  tail  pendant  and  head 
inclined  towards  the  ground,  its  eyes  wandering  and 
frequently  squinting,  and  its  mouth  open,  with  the 
bluish-colored  tongue,  soiled  with  dust,  protruding.  In 
this  condition  it  has  no  longer  the  violent,  aggressive 


136 


HYDROPHOBIA. 


tendencies  of  the  previous  stage,  though  it  will  yet  bite 
every  one,  man  or  beast,  that  it  can  reach  with  its  teeth, 
especially  if  irritated. 

20.  The  mad  dog  that  is  not  killed  perishes  from 
paralysis  and  asphyxia.  To  the  last  moment,  the  ter- 
rible desire  to  bite  is  predominant,  even  when  the  poor 
creature  is  so  prostrated  as  to  appear  to  be  transformed 
into  an  inert  mass. 

Upon  the  first  appearance  of  any  suspicious  symp- 
toms, the  animal  should  be  isolated  and  very  carefully 
watched.  It  is  an  error,  as  common  as  it  is  cruel,  that 
a dog  who  has  bitten  any  animal  should  be  killed  at 
once.  Should  this  accident  occur,  the  animal  should  be 
kept  by  himself,  and  each  day  the  progress  of  the  case 
should  be  noted.  If  the  disease  should  not  be  hydro- 
phobia, we  have  the  comforting  assurance  of  immunity 
from  painful  sequelae  to  those  who  may  have  been  bit- 
ten. On  the  other  hand,  if,  as  is  too  commonly  the 
case,  the  dog  should  be  immediately  killed,  a constant 
dread  would  surround  the  patient — a fear  that  at  some 
remote  period  hydrophobia  might  be  developed.  In 
this  way  most  disastrous  nervous  conditions  may  be 
engendered.  Never  kill  a dog  until  the  symptoms  of  hy- 
drophobia are  beyond  the  question  of  a doubt.  The  influ- 
ence of  sex  upon  the  spontaneous  appearance  of  hydro- 
phobia is  not  as  great  as  is  generally  supposed,  and  Dr. 
Dolan  seems  to  doubt  if  it  have  any  weight  whatever. 
On  the  other  hand,  M.  Renault,  Inspector  of  the  French 
Veterinary  schools,  has  asserted  that  the  disease  is  only 
spontaneous  in  the  male.  The  influence  of  the  genera- 
tive act  in  producing  the  disease  is  equally  uncertain. 


HOW  TO  TREAT  EMERGENCIES. 


137 


Upon  this  point  Dr.  Dolan  writes:  ^^At  present  we  can 
only  deem  it  probable  that  there  may  be  some  founda- 
tion for  the  supposition  that  intense  sexual  excitement 
may  produce  rabies,  especially  when  the  desire  is  not 
capable  of  being  gratified.  The  relation  of  the  periods 
of  Abutting ^ must  also  be  taken  into  consideration. 
The  dog-bitch  is  usually  in  rut  in  February  and  Au- 
gust, and  if  procreation  does  not  take  place,  it  is  some- 
times renewed  three  months  later,  in  May  and  Novem- 
ber. Of  course,  in  domesticity  there  are  exceptions  to 
this  rule.  The  cat  usually  ruts  in  spring  and  autumn, 
but  is  also  affected  by  domestic  habits.  The  female  fox 
commences  to  be  in  rut  about  January  and  February, 
and  the  she-wolf,  when  aged,  towards  the  end  of  Decem- 
ber and  in  January.  Younger  animals  are  so  in  Feb- 
ruary and  the  beginning  of  March.  If  the  production 
of  rabies  was  at  all  connected  with  this  condition  of  the 
generative  system,  then  we  might  expect  the  malady 
would  be  only  prevalent  at  the  period  when  rutting  is 
general,  whereas  we  find  it  is  observed  at  all  seasons ; 
indeed,  if  the  causes  enumerated  were  at  all  influential 
in  producing  the  disease,  we  should  not  only  have  it 
much  more  frequently  than  it  now  is,  but  it  would  be 
common  in  countries  where  it  is  very  rare  and  never 
witnessed,’^ 

Rabies  attacks  all  breeds  of  dogs  indiscriminately. 
Eckel  gives  the  following  percentage  : — 

Mongrels  of  all  kinds 53J  per  cent. 


Small  English  breed 

Fox  hounds 

Poodles..  


10 


138 


HYDROPHOBIA. 


Pomeranians 

Danish  clogs  and  pointers. 

Pugs  and  turnspits 

Mastiffs 

Hounds 
Sheep  dogs 


27  per  cent. 
2f 
2} 

13  a a 

6f 


Saint  Cyr  furnishes  the  following  : — 


Hounds 

Spaniels 

Pomeranians 

Mastiffs 

Bull  and  house  dogs 

Newfoundland  dogs..... 

Mongrels 

Mon  tons  

-Terriers,  greyhounds.... 
King  Charles,  pug 


3) 
16) 
12-) 
6 ! 
4 

3 

4 
2 
2 
2 


I 


35  per  cent. 


46.20  percent. 


18.80 


In  every  instance  it  must  be  strenuously  denied  that 
a bite  from  a healthy  dog,  whether  he  be  angry  or  not, 
whether  in  rutting  season  or  not,  can  produce  the  disease 
known  as  rabies.  ^‘The  influence  of  certain  seasons  in 
inducing  the  production  of  rabies  has  long  been  a popu- 
lar notion,  which,  it  would  appear,  the  stern  testimony 
of  facts  has  not  been  quite  potent  enough  to  dispel. 
During  the  hot  weather— the  ^ dog  days,^  as  a certain 
portion  of  the  summer  has  been  designated — it  has  been 
universally  believed  that  the  canine  race  is  particularly 
liable  to  be  attacked  by  madness,  possibly  from  the  ap- 
parent distress  dogs  manifest  when  exposed  to  heat,  as 
evidenced  by  restlessness,  panting,  thirst,  etc.  This 
popular  notion  that  rabies  is  more  common  in  summer 
than  winter  is  of  the  highest  antiquity,  and  seems  to 


HOW  TO  TREAT  EMERGENCIES. 


139 


have  been  connected  in  some  way  with  the  celebration 
of  the  festum  Cynophontia  of  the  Argives.  But  is  it 
the  case  that  rabies  is  more  frequent  in  hot  than  in  cold 
or  temperate  weather,  or,  in  other  words,  that  heat  in- 
duces the  disease?  The  evidence  furnished  by  statistics 
compiled  in  France  and  Germany  incontestably  proves 
that  it  is  not  during  hot  Aveather  that  rabies  is  most 
prevalent,  but  during  the  cold  and  mild  seasons.  * * 

The  best  veterinarians  agree  that  meteorological  condi- 
tions and  the  different  seasons  have  little  effect  in  excit- 
ing or  determining  the  ev^olution  of  spontaneous  rabies, 
and  that  it  is  a disease  which  may  appear  in  any  season, 
or  in  any  kind  of  weather.^’  (Dolan,  op.  cit.) 

Emergencies, — A person  at  a distance  from  medical 
assistance  has  been  bitten  by  a dog  sup[)Osed  to  be  rabid  : 
Avhat  must  be  done?  Place  at  once  a tight  bandage  above 
the  bite,  between  it  and  the  heart,  so  as  to  arrest  the 
circulation  in  the  part,  then  allow  a stream  of  water  to 
pour  freely  over  the  wound.  After  fifteen  minutes, 
dissect  out  the  part  bitten,  or  cauterize  with  an  iron' at 
white  heat — nitrate  of  silver  is  objectionable,  on  account 
of  subsequent  bleeding.  Fuming  nitric  acid  is  the  best 
agent  to  use  next  to  the  actual  cautery.  Give  whisky 
or  ammonia  freely.  Calm  the  nervous  system,  Avith  the 
assurance  that  the  danger  of  hydrophobia  is  nil,  if  the 
local  trouble  be  taken  in  time.  If  it  be  possible,  place 
the  dog  under  the  strictest  surveillance.  If  rabies  does 
not  develop,  Ave  can  assure  the  patient  absolutely  that 
there  is  no  possible  ground  for  alarm.  These  prelimi- 
naries having  been  carried  out  faithfully,  consult  the 
nearest  physician  without  delay.  If  it  be  impossible  to 


140 


HYDROPHOBIA. 


obtain  the  hot  iron^  flash  some  gunpowder  in  the  wound. 
Should  this  be  impossible,  open  the  wound  freely  with  a 
pocket  knife,  so  as  to  encourage  copious  bleeding,  then 
pack  the  opening  with  moist  clay.  Be  cool.  Act  quick- 
ly. The  probabilities  are  largely  in  favor  of  any  one 
bitten  if  timely  precautions  are  made  use  of. 


CURIOSITIES  OF  LITERATURE. 


141 


CHAPTER  X. 

CURIOSITIES  OF  LITERATURE. 

Although  the  various  pilgrimages  have  lost  their 
reputation  since  the  Revolution^  yet,  to-day  the  relics  of 
Saint  Hubert  are  much  esteemed,  and  a large  number  of 
people  who  have  been  bitten  by  rabid  dogs,  or  reported 
so  to  be,  expect  to  find  in  these  a preventive  of  the  dis- 
ease. Arriving  at  Saint  Hubert,  the  patient  presents 
himself  at  the  church,  the  priest  makes  a slight  incision 
upon  the  forehead,  and  instead  of  placing  in  it  a thread 
of  the  sainted  stole,  as  the  common  people  suppose,  he 
introduces  an  irritating  herb.  He  binds  the  head  with 
a bandage ; he  orders  a certain  course  of  living  for  six 
weeks ; on  the  ninth  day  the  bandage  is  removed,  and 
solemnly  burned  in  the  choir  of  the  church  ; his  conva- 
lescence is  celebrated  with  pomp,  and  upon  the  fortieth 
day  the  cure  is  entirely  accomplished.  The  rules  pre- 
scribed by  the  priest  are  as  follows  : Not  to  wash  or 
change  the  linen,  to  eat  every  day  out  of  the  same  dish, 
to  drink  no  white  wine,  avoid  looking  at  himself,  and 
in  walking  look  always  in  front,  etc.  {Rev,  Encyc, 
Janvier,  1820.)  In  Italy,  it  is  sufficient  for  the  cure  of 
hydrophobia,  that  one  should  touch  the  keys  of  the 
church  in  which  Beilin,  a priest  of  Padua,  a town  fifteen 
miles  from  Rovigo,  is  buried.  The  keys  of  the  churches 
of  Saint  Guilterie,  of  Saint  Roch,  of  Saint  Pierre  de 
Bruges,  are  said  to  possess  similar  virtue.’^  (Translated 
form  the  Dictionnaire  Eyicyclopedique  des  Soiences  Medi- 


142 


HYDEOPHOBIA. 


Gales.)  Pliny  [Hist,  Nat,,  lib.  xxix)  advises  the  use  of 
the  liver  of  a mad  dog.  The  menstrual  fluid  of  a womaUj 
and  the  urine  of  a virtuous  young  man,  have  also  been 
recommended.  The  Prussian  electuary,  bought  by 
Frederick  the  Great  from  a peasant  of  Silesia,  consisted 
of  cantharides  taken  internally,  and  applied  externally 
to  the  wound.  The  celebrated  Chinese  Tonquin  pow- 
der was  composed  of  16  grains  of  musk,  20  grains  of 
native  cinnabar  and  20  grains  of  cinnabar  of  antimony, 
to  be  taken  in  a glass  of  brandy.  The  magic  omelet 
was  made  as  follows : Bake  the  shells  of  the  male 
oyster,  reduced  to  powder,  mix  with  eggs  and  beat  up 
with  oil,  etc.  The  Swartzenberg  and  Paulmier  powders, 
have  also  had  their  advocates.  Dr.  Holland’s  list  of 
remedies  which  have  been  used  in  the  treatment  of  this 
dfsease  is  inexhaustible  : among  the  number  we  And  : 
Pounded  ants,  badger  soup,  the  excrement  of  a calf,  the 
brains  and  comb  of  a cock,  cuckoo  soup,  carral,  the  blood 
and  purifled  excrement,  liver,  urine,  the  worm  under 
the  tongue  of  a mad  dog,  the  liver  of  a male  goat,  horse 
dung,  the  tail  of  a strew  mouse,  flesh  of  the  unicorn, 
mad  wort,  and  other  palatable  compounds  of  like  nature. 
Dioscorides,  Celsus,  JEtius,  Galen,  Latta  and  Buken- 
hbut  have  lauded  sucking  the  wound.  This  custom 
dates  back  to  the  time  of  Cleopatra,  and  history  recounts 
the  exploit  of  Eleanor,  who  sucked  the  wound  of  King 
Edward  I.  Still  grosser  superstitions  exist  in  refer- 
ence to  smothering,”  writes  Dr.  Dolan  ; an  historical 
mode  of  death  familiar  to  the  readers  of  history  in  con- 
nection with  King  Edward  V and  his  brother;  while 
Shakspeare  has  immortalized  it  by  making  Othello, 


CURIOSITIES  OF  LITERATURE. 


143 


through  jealousy,  smother  Descleraona.  On  some  such 
plea  as  the  words  uttered  by  Othello,  suffocation  was 
resorted  to — 

‘‘  ‘ I that  am  cruel,  am  yet  merciful : 

I would  not  have  thee  linger  in  thy  pain.’  ” 

Act  V,  Scene  it 

There  are  not  only  traditions  of  the  suffocation  of  the 
unfortunate  victims  between  feather  beds,  but  we  have 
evidence  of  the  existence  of  the  custom.  We  have  se- 
lected a few  cases  from  Notes  and  Q aeries. 

In  the  Dablin  Ohroniele^  October  28th,  1798,  the 
following  circumstances  are  recorded : A fine  boy,  aged 
fourteen,  was  bitten  by  a lady’s  lap  dog,  at  Black  Rock, 
near  Dublin.  In  about  two  hours  the  youth  was  seized 
with  convulsive  fits,  and  shortly  after  with  hydrophobia; 
and  notwithstanding  every  assistance,  his  friends  w^ere 
obliged  to  smother  him  between  two  feather  beds. 
[Notes  and  Queries,  2d  ser.,  vol.  ix,  p.  454.)  We  need 
only  say  this  was  not  a case  of  rabies,  as  it  never  devel- 
ops within  such  a period,  and  as  for  the  authenticity  of 
the  statement  we  do  not  vouch. 

Mr.  G.  R.  Jesse,  Hendbury,  Cheshire,  in  Notes  and 
Queries,  vol.  x,  p.  382,  also  informs  us  that  sufferers 
Avere  bled  to  death  or  smothered.  A man  in  the  Revo- 
lution murdered  his  brother  under  this  pretext.”  Dan- 
iels’ Rural  Sports  mentions,  I think,  an  instance  of 
smothering  rabid  patients  between  feather  beds,  and  that 
the  parties  were  tried  and  acquitted.  See,  likewise, 
Scot’s  British  Fie'd  Sports,  1818,  p.  195,  for  a case  of 
bleeding  to  death ; in  the  same  disease,  people  appear  to 
have  been  poisoned  or  drowned.  There  are  many  local 


144 


HYDROPHOBIA. 


traditions,  also,  in  regard  to  this  smothering.  There  was 
a current  belief  through  the  north  of  Scotland,  sixty 
years  ago,  that  a Countess  of  Fife,  about  the  end  of  last 
century,  or  the  beginning  of  the  present,  while  fondling 
her  lap  dog,  had  been  bitten  in  the  lip,  and  was  seized 
with  hydrophobia,  and  when  all  hope  of  cure  was  at  an 
end,  was  smothered  between  two  feather  beds. 

In  the  Irish  Times  of  May  18th,  1861,  we  find  the 
following : — 

Case  of  Hydrophobia,  Melancholy  Occurrence. — A 
fatal  case  of  hydrophobia  is  reported  from  Newport, 
County  Tipperary,  the  victim  being  a fine  young  woman. 
It  appears  that  while  being  engaged  in  some  outdoor 
employment,  a neighbor’s  dog  bit  her  in  the  hand.  Hy- 
drophobia in  its  most  fearful  aspect  set  in,  and  she  became 
so  hopelessly  mad  that  it  was  found  necessary  to  smoth- 
er her  between  two  feather  beds.  (Notes  and  Queries, 
2d  series,  vol.  ix,  p.  478.) 

In  the  Guardian  of  April  3d,  1867,  it  was  also  said 
to  be  announced  that  a little  daughter  of  Mr.  A.  Wood- 
ruff, of  the  town  of  Greenfield,  Michigan,  having  been 
seized  with  hydrophobia,  a consultation  was  held  by  the 
physicians,  who  decided  that,  as  the  patient  could  not 
possibly  survive,  every  consideration  of  humanity  de- 
manded that  her  sufferings  be  ended  by  some  means,  in 
accordance  Avith  which  the  child  was  smothered  to  death. 
(Notes  and  Queries,  3d  series,  vol.  ii,  p.  376.) 

From  Notes  and  Queries,  1st  series,  vol  x,  p.  469,  Ave 
learn,  that  at  an  inquest  held  in  October,  1866,  at  Brad- 
Avell,  Bucks,  on  the  body  of  a child  Avho  had  died  from 
hydrophobia,  evidence  Avas  given  of  a practice  almost 


CURIOSITIES  OF  LITERATURE. 


145 


incredible  in  civilized  England.  A witness  stated  that 
she  had  fished  out  of  the  river  the  dead  body  of  the  dog 
which  had  inflicted  the  bite^  taken  out  its  liver,  fried  a 
bit  of  it  on  the  fire,  and  given  it  to  the  child  to  eat. 

In  reference  to  the  power  of  curing,  Mr.  Francis 
Robert  Davis  writes  to  Notes  and  Queries  (1st  series, 
vol.  ix),  that  a man  named  Monsel,  living  at  Kilrush, 
in  the  County  Clare,  possessed  a cure  for  hydrophobia 
which  was  never  known  to  fail.  He  required  that  the 
patient  should  be  brought  to  him  nine  days  from  the 
time  of  his  being  bitten,  when  he  made  him  look  into  a 
pail  of  water,  or  a looking  glass.  If  he  bore  that  trial 
without  showing  any  uneasiness,  he  declared  there  was 
no  doubt  of  his  being  able  to  effect  a cure.  He  then 
retired  to  another  room,  leaving  the  patient  alone  for  a 
short  time,  and  when  he  returned  he  brought  two  bits 
of  cheese  which  he  said  contained  the  remedy,  and  caused 
the  person  to  swallow  them.  He  then  desired  him  to 
return  home,  and  for  nine  days  frequently  drink  a few 
sips  of  water,  and  also  take  opportunities  of  looking  at 
water  or  a looking  glass,  so  as  to  get  the  nerves  under  con- 
trol. He  acted  evidently  on  the  imagination  of  the  pa- 
tient. The  following  is  from  the  People,  Wexford,  Ire- 
land : — 

Certain  Cure  for  the  Bite  of  a Mad  Dog, — We  have 
been  favored  with  the  following  recipe,  which,  we  learn, 
has  been  used  by  a family  in  this  country  for  gener- 
ations with  unfailing  success  in  preventing  the  terrible 
effects  that  follow  the  bite  of  a mad  dog: — 

^^Take  three  wineglassfuls  of  the  juice  of  the  narrow 
rib-leaf  (plantago  minor),  also  called  narrow-leafed  plan- 


146 


HYDEOPHOBIA. 


tain  and  narrow  rib-wort;  one  wineglassful  of  common 
salt^  and  one-quarter  of  a pound  of  butter.  Mix  and 
simmer  gently  for  twenty  minutes.  Take  a wineglass- 
ful in  the  morning — no  food  to  be  taken  for  at  least  an 
hour  after ; take  a second  wineglassful  the  same  even- 
ing— no  food  to  be  used  for  at  least  one  hour  before  or 
after ; take  a third  wineglassful  on  the  second  morning 
— no  food  to  be  taken  for  at  least  one  hour  before  or 
after  taking  it.  Many  persons  in  the  country  will  recol- 
lect this  cure  being  applied  for  in  the  vicinity  of  New 
Ross,  and  of  its  being  used  with  success.  It'  is  prevent- 
ive, when  used  by  either  man  or  beast,  of  the  effects  of 
the  bite  of  a mad  dog.^^ 

In  West  Prussia  an  incantation  practiced  very  exten- 
sively consisted  of  the  words  Pax,  Max,  Imax,^^  writ- 
ten with  a piece  of  wood  three  times  on  a slice  of  but- 
tered toast,  to  be  eaten  by  the  patient. 

The  most  curious  of  these  charms  is  one  said  to  be 
practiced  in  Russia.  It  consists  of  the  following  form 
of  words  and  signs  also  scratched  on  buttered  toast,  to 
be  eaten  by  the  patient: — 

+ Iryon*  + Syryon  + Kiryon  + 

Karyon  + Koforyn  + Styleda  + 

Staletura  ^ Kakara  + Idota  + 

Strydota  + Syon  + Bryan  + 

Et  + Deus  + Mens.  + 

Holland  says : This  is  not  Russian,  but  the  last 
three  words  are  Latin.^^ 

Desault  mentions  that  the  Church  of  St.  Villa,  in 
Poiiille,  was  very  celebrated  for  the  prevention  of  rabies. 


CUKIOSITIES  OF  LITERATURE. 


147 


The  person  who  applied  for  relief  making  the  tour  of 
the  church  every  night  for  three  weeks^  singing  the  fol- 
lowing hymn  : — 

Alma  vitse  Pellicane, 

Oram  qu^  tenes  Apulam, 

Litusque  Pollignanicum, 

Irasque  canum  mitigas ; 

Tu  Sancte  rabiem  asperam 
Rectusque  canis  luridos 
Tu  saevam  prohibe  luern. 

I procul  hinc  rabies 

Procul  hinc  furor  omnis  abesto?” 

As  an  illustration  of  what  curious  superstitions  still 
lurk  among  rural  populations^  the  Students^  Journal^ 
1877,  mentions  that  at  Rivesaltes,  in  the  south  of 
France,  some  terrible  cases  of  hydrophobia  have  re- 
cently occurred.  The  local  authorities,  therefore,  deter- 
mined to  adopt  preventive  measures,  and  accordingly 
sent  for  some  salondadonSyOV^  as  we  should  say,  f^eventh 
sonSj  who  in  those  districts  are  believed 4o  have  the  mi- 
raculous power  of  curing  the  bites  inflicted  by  mad  dogs, 
and  of  blessing  small  pieces  of  bread  called  passagnats, 
which  are  supposed  to  ward  oif  hydrophobia.  The 
salondadon  performs  his  cures  by  means  of  a crucifix, 
uttering  the  while  sacramental  words  from  a liturgy 
peculiar  to  himself.  The  seventh  sons  are  supposed  to 
have  a variety  of  other  powers  not  granted  to  ordinary 
mortals,  such  as  treading  under  foot  or  applying  to  the 
tongue  a bar  of  red-hot  iron  without  receiving  any 
injury. 


148 


HYDROPHOBIA. 


CHAPTER  XI. 

THE  MOST  RECENT  VIEWS  OF  THE  PATHOLOGY  AND 
TREATMENT  OF  HYDROPHOBIA. 

Several  cases  reported  in  the  winter  of  1880-81  illus- 
trate the  most  recent  views  on  the  pathology  and  treat- 
ment of  hydrophobia: — 

In  the  Journal  of  Anatomy  and  Physiology  there  is  a 
paper  by  Dr.  George  Middleton,  Assistant  to  the  Pro- 
fessor of  the  Practice  of  Medicine  in  the  University  of 
Glasgow,  chiefly  founded  on  observations  made  on  two 
cases  of  hydrophobia  which  were  under  the  care  of  Pro- 
fessor Charteris.  Briefly,  the  lesions  found  might  be 
said  to  be  an  almost  universally  increased  vascularity, 
often  venous,  but  also  referable  to  the  smaller  arteries, 
of  the  different  organs  and  tissues  of  the  body,  coupled 
with  frequent  hemorrhages,  often  punctiform  in  charac- 
ter, together  with  a great  tendency  to  the  accumulation 
of  leucocytes  in  the  vessels,  perivascular  spaces,  and 
surrounding  structures,  more  especially  of  the  nervous 
system.  These  perivascular  changes  were  chiefly  noted 
in  the  lower  part  of  the  brain  and  upper  part  of  the 
spinal  cord,  where  the  leucocytes  sometimes  formed 
small,  rounded  masses,  which  might  be  called  miliary 
abscesses.  In  both  cases  examined  numerous  vessels 
were  seen,  clothed  with  round  cells — a condition  which 
in  the  second  case  became  clearly  less  intense  as  the 
sections  were  made  lower  in  the  cord.  The  gray  matter 
was  chiefly  affected,  due,  as  has  been  pointed  out  by 


RECENT  VIEWS  OF  PATHOLOGY,  ETC.  149 

others,  to  the  greater  frequency  of  vessels  tliere.^^  No 
special  aggregation  of  leucocytes  was  observed  in  the 
spaces  round  the  larger  ganglion  cells,  as  had  been 
noted  by  Coats ; nor  were  they  grouped  in  any  unusual 
or  striking  fashion  round  the  nuclei  of  the  hypoglossal, 
glosso-pharyngeal  and  vagus,  as  noted  by  Gowers. 

From  this  it  will  be  seen  that,  apart  from  the  general 
characteristics  of  the  morbid  appearances  already  indi- 
cated, especially  the  tendency  to  the  accumulation  of 
leucocytes  around  the  smaller  blood-vessels  and  in  the 
neighboring  tissues,  there  is  no  definiteness  or  uniformity 
in  the  pathological  conditions  found  after  death  in  dif- 
ferent cases  of  hydrophobia.  This,  again,  is  in  itself 
sufficient  to  show  that  in  these  appearances  we  have  no 
clue  to  the  causation  of  the  highly  characteristic  and 
most  distressing  symptoms  of  the  malady. 

But  Dr.  Middleton  has  gone  further  than  this.  He 
selected  twenty-four  cases,  not  taken  consecutively,  but 
selected  in  the  post-mortem  room,  as  more  or  less  likely 
to  have  been  connected  with  nervous  symptoms.  The 
central  nervous  system  was  first  examined,  roughly  and 
microscopically,  and  subsequently  the  clinical  records 
were  consulted  as  to  the  actual  symptoms  during  life. 
The  results  thus  obtained  were  striking.  In  a case  of 
purpura  hsemorrhagica  the  microscojie  revealed  an  ex- 
ceedingly well-marked  lesion  of  the  vessels,  quite  similar 
to  that  seen  in  hydrophobia.’^  Of  three  cases  of  diabetes, 
one  showed  lesions  similar  to  but  not  so  pronounced 
as  in  hydrophobia.”  The  lesions  described  by  Dickin- 
son as  existing  in  diabetes  were  not  seen.  Four  cases 
of  head  injury  ‘^all  showed  a lesion  similar  to  that 


1-50 


HYDEOPHOBIA. 


found  in  hydrophobia,  but  in  two  of  them  it  was  very 
slight.  In  all  there  was  great  cerebral  excitement,  and 
the  case  in  which  this  lasted  for  the  shortest  time  showed 
least  evidence  of  the  perivascular  lesion. In  one  case 
of  delirium  tremens  coupled  with  injury  and  erysipelas 
there  were  marked  perivascular  changes.  In  another, 
of  delirium  tremens  pure  and  simple,  there  were  hardly 
any ; but  the  examination  was  incomplete.  In  a case 
of  opium  poisoning  there  were  none.  In  a case  of  hy- 
drocephalus with  marked  cerebral  symptoms  there  were 
none.  In  two  cases  of  tubercular  meningitis  they  were 
marked.  In  one  case  of  tetanus  they  were  marked;  in 
another  doubtful,  but  ^Hhe  nerve-tissue,  especially  in 
the  pons,  presented  numerous  rounded  gaps,  with  regular 
outlines.^^  Of  two  cases  of  Bright^s  disease  with  uraemic 
symptoms  the  same  lesion  as  in  hydrophobia  was  seen 
around  the  vessels  of  the  medulla,  the  pons,  the  optic 
thalami  and  corpora  striata,  especially  in  the  medulla. 
In  another  case,  where  the  uraemic  symptoms  only  lasted 
twenty-four  hours,  the  appearances  were  similar,  but 
less  intense.  Briefly,  therefore,  the  author  concludes 
that  the  perivascular  lesion  is  by  no  means  character- 
istic of  hydrophobia;  that  it  is  commonly  found  in  cases 
characterized  by  cerebral  excitement,  and  that  the  inten- 
sity of  the  lesion  varies  directly  with  the  intensity  and 
duration  of  the  cerebral  symptoms.^^ 

Probably  it  is  not  safe  to  go  further  than  the  proposi- 
tions put  by  Dr.  Coats,  viz.:  ^4hat  in  hydrophobia  there 
is  an  irritant  in  the  blood  which  attacks  a considerable 
number  of  organs,  the  signs  of  irritation  being  most 
manifest  in  the  neighborhood  of  the  finer  blood-vessels ; 


RECENT  VIEWS  OF  PATHOLOGY,  ETC.  151 

that  it  is  probable  that  this  irritant  attacks  some  vessels 
more  than  others,  especially  those  of  the  central  nervous 
system ; that  in  the  nervous  system  the  medulla  oblon- 
gata and  spinal  cord  are  most  the  subject  of  the  lesion, 
which  scarcely  shows  itself  in  the  higher  centres/^  This 
by  no  means  excludes  the  possibility  of  local  changes 
similar  to  those  found  in  hydrophobia  being  associated 
with,  cerebral  excitement.  But  cerebral  excitement  is 
one  thing,  and  motor  acts  which  we  are  accustomed  to 
refer  specially  to  the  medulla  and  cord  are  another. 

From  the  same  source  is  the  following  instance  of  the 
use  of  pilocarpin  as  a remedy.  The  case  was  laid  before 
the  Glasgow  Medico-Chirurgical  Society,  by  Dr.  Char- 
teris.  He  said  : — 

^‘Pilocarpin  was  the  remedy  employed  in  this  case,  and  it  was 
at  one  time  hoped  that  the  trial  would  have  justified  its  selection  ; 
for  the  patient  was  a muscular  athlete,  tall,  strong  and  wiry,  whose 
constitution  was  unimpaired  by  previous  illness,  and  who  had,  as 
he  said,  ‘ neither  tasted  drink  nor  smoked  tobacco  in  his  life.’  The 
drug  lowered  the  temperature,  promoted  copious  salivation  and 
perspiration,  and,  strange  to  say,  the  inability  to  swallow  was  en- 
tirely removed,  and  the  gloominess  that  hung  over  the  patient  at 
first  was  succeeded  by  wild  bursts  of  delirious  joy,  with  fanciful 
pictures  of  happiness  and  peace.  The  struggle,  fierce  and  terribly 
violent,  which  lasted  four  days,  seemed  to  exhaust  the  man,  and 
without  convulsions  and  without  terror  he  sank  and  died.  The 
clinical  record  of  this  case,  after  it  had  been  decided  to  try  pilo- 
carpin, is  as  follows:  At  9.45  a.  m.,  when  first  seen,  his  pulse  was 
150  and  his  temperature  102  6°.  One-third  of  a grain  of  pilocarpin 
’svas  injected,  and  in  about  three  minutes  afterwards  he  began  to 
hawk  and  spit  profusely,  and  this  was  followed  by  a copious  per- 
spiration. At  11.15  the  injection  was  repeated,  causing  the  same 
symptoms ; and  when  seen  at  12  he  was  lying  comparatively  quiet 
and  ‘ sweating  awfully,’  as  he  said.  His  temperature  had  fallen  to 
101°,  fully  a degree  and  a half,  his  pulse  being  140.  At  2 p.  m.  the 


152 


HYDROPHOBIA. 


reduction  of  temperature  was  more  noted,  as  it  was  100°,  and  his 
pulse  was  130.  At  4 p.m.  he  complained  of  severe  pain  in  the 
back  of  his  head,  for  which  a poultice  was  applied.  He  now  asked 
for  a drink  of  milk.  The  nurse  steadied  his  hand  and  assisted 
him  to  bring  the  cup  to  his  head  ; wheu  it  was  there  he  threw  the 
milk  into  his  mouth  as  a man  might  do  a pill,  and  swallowed  it 
with  a great  gulp.  After  he  had  done  this,  he  rose  to  his  full 
height  in  bed  and  said,  ‘I  have  swallowed  at.  last.  I am  a cured 
man.  I’ll  go  home  to-morrow  ; but  don’t  mind  me,  don’t  mind 
me,  when  I get  out.’  Everything  was  done  to  foster  the  idea  that 
he  was  getting  better,  and  he  promised  money  and  the  eternal 
gratitude  of  himself  and  family,  adding,  ^ The  Vale  of  Leven  will 
wonder  when  they  see  me  back  a cured  man.’  At  6 p.m.  pilo- 
carpin  was  repeated,  but  the  result  was  not  the  same  as  before,  for 
little  perspiration  was  induced,  but  instead  copious  micturition. 
His  temperature  had  again  risen  to  102°,  and  his  pulse  was  160. 
At  9 P.M.  his  condition  with  regard  to  temperature  and  pulse  was 
unaltered,  and  he  talked  incessantly.  Bromide  of  potassium  was 
given  in  large  doses,  but  no  sleep  was  obtained.  At  9 a.m.,  when 
again  seen,  he  said  he  had  not  slept,  for  men  had  come  in  and  sat 
on  him,  bruising  him  much  all  down  the  back.  His  temperatnre 
was  102°.  Pilocarpin  was  again  injected,  but  little  perspiration 
was  induced.  At  12,  three  hours  afterwards,  pain  was  experienced 
over  the  kidney,  and  a trace  of  albumen  detected  in  the  urine.  He 
saw  his  wife,  at  his  own  request,  and  to  show  her  he  was  better  he 
took  some  milk  with  an  effort,  but  no  particular  spasm.  He  had 
taken  in  all,  since  his  amendment,  two  pots  of  Brand’s  essence  of 
beef.  At  4 p.m.  the  nurse  stated  he  had  dozed  about  ten  minutes 
at  a time,  but  he  had  had  no  sound  sleep.  He  appeared  much 
excited  about  being  beaten.  Later  on  he  slept  about  an  hour, 
after  having  an  egg  beat  up  with  brandy,  and  on  awakening  he 
took  a slice  of  bread  soaked  in  water  and  some  essence  of  beef. 
During  the  remainder  of  the  day  and  the  following  morning  he  was 
simply  exhausted,  through  constant  talking  and  want  of  sleep,  but 
he  could  swallow  easily.  At  9 a.m.  he  wished  to  go  out,  and  actu- 
ally reached  the  door,  but  was  persuaded  to  return.  His  ex- 
haustion was  very  intense  and  the  albumen  in  the  urine  very 
abundant.  At  noon  of  the  same  day  he  died.” 


RECENT  VIEWS  OF  PATHOLOGY,  ETC.  153 

In  the  British  Medical  Journal  for  1878,  Dr.  J.  G.  S. 
Coghill  has  an  article,  Jaborandi  proposed  as  a remedy 
in  Hydrophobia,  from  observations  of  two  cases  of  the 
disease  observed  in  man,^^  and  in  the  American  Journal 
of  Medical  Sciences,  1878,  Dr.  W.  J.  Forbes  extols  the 
use  of  nitrite  of  amyl  in  mitigating  the  paroxysms  of 
pain.  The  patients  upon  whom  pilocarpin  was  tried 
died  from  extreme  exhaustion — a condition  which,  it  is 
J alleged,  may  be  attributable  to  the  severity  of  the  dis- 
ease rather  than  to  the  effects  of  the  drug.  The  hydro- 
phobic  convulsions  had  so  lowered  the  vitality  before 
the  treatment  with  pilocarpin  was  commenced  that  the 
patients  were  unable  to  rally,  although  the  painful 
manifestations  of  the  disease  were  magically  dissipated. 
For  nitrite  of  amyl  nothing  is  claimed  more  than  that 
it  exerts  a calming  influence.  Pilocarpin  is  a paralyzant 
of  the  vaso-motor  nervous  system.  It  reduces  tempera- 
ture by  the  profuse  transpiration  which  it  causes  and  by 
depressing  the  vascular  tonus.  It  reduces  the  arterial 
tension  and  increases  the  heart-action.  It  enormously 
increases  the  amount  of  urea  passed  out  in  the  sweat. 
If  a case  of  hydrophobia  should  be  seen,  upon  the  first 
appreciable  manifestation  of  the  disease  the  exhibition 
of  jaborandi,  or  of  its  active  principle,  might  possibly 
be  attended  with  good  results,  although  I am  unable  to 
explain,  upon  any  logical  deductions  of  physiological 
therapy,  why  we  should  expect  such  favorable  action  in 
any  other  way  than  by  supposing  that  the  diminution 
of  the  vascular  tonus,  with  the  excessive  transpiration 
and  reduced  arterial  tension,  may  ultimately  prevent  the 
terrible  nervous  irritation.  This  state  of  nervous  ex- 


11 


154 


HYDROPHOBIA. 


citem^ent  never  obtains  primarily  as  a distinct  neurosis^ 
but  is  preceded  by  a symptomatology  of  blood  poisoning, 
and  it  is  to  this  mal-nutrition  that  the  nervous  lesion  is 
due.  Hence,  should  pilocarpin  aid  in  withdrawing  from 
the  system  the  noxious  principles  that  interfere  with 
normal  blood  nourishment,  it  would  serve  an  admirable 
purpose.  The  exciting  cause  of  the  nervous  disorder 
AvoLild  be  taken  out  of  the  system  before  it  could  excite 
to  action  that  secondary  manifestation  of  which  the 
altered  blood  supply  was  the  first.  We  must  consider, 
however,  the  alarming  exhaustion  which  very  generally 
follows  upon  the  use  of  any  of  the  preparations  of  jabo- 
randi.  Can  we  afford,  at  any  stage  of  the  disease,  to 
lower  the  strength  of  the  patient?  Will  not  this  induced 
condition  of  physical  exhaustion  give  rise  to  the  very 
train  of  nervous  symptoms  which  we  are  trying  to 
avert  ? 

Recent  pathology  seems  to  sustain  the  opinion  which 
I advanced  in  preceding  chapters  of  this  work.  I have 
no  reason  to  depart  from  such  impression,  and  I still 
believe  that  if  we  are  to  treat  hydrophobia  successfully 
we  must  do  so  by  making  use  of  those  remedies  which 
will  act  directly  upon  the  blood.  The  primary  excitant 
is  a blood  irritant,  which  addresses  itself  chiefly  to  the 
finer  vessels  supplying  the  central  nervous  system. 
The  condition  of  disorganization,^^  founded  upon  post- 
mortem examination  of  the  cord,  is  an  effect  of  the 
altered  blood  supply,  and  cannot  now  be  regarded  in 
any  sense  as  a primary  lesion. 


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cine— the  actual  business  of  the  doctor — the  leading  feature  in  its  pages. 
Hence  the  lectures,  articles,  hospital  reports  it  gives,  are  mainly  devoted 
to  pathology,  diagnosis,  surgery  and  therapeutics,  rather  than  to  matters 
of  theory,  scientific  curiosities,  or  recondite  research.  This  will  continue 
to  be  its  aim. 

It  has  also  been  its  object  to  be  broadly  national  in  tone  and  in 
value.  Its  contributions  are  sought  in  all  parts  of  the  Union ; no  society, 
college  or  clique  controls  it.  It  is  a perfectly  independent  organ  of  the 
whole  regular  and  scientific  profession  of  medicine.  As  such,  it  will 
continue.  * 

In  the  department  of  Ateirs,  the  Eeporter  is  intended  to  be,  in 
the  full  sense  of  the  word,  a medical  newspaper.  Its  weekly  visits  will 
keep  the  isolated  practitioner  fully  conversant  with  all  that  is  going  on 
in  the  great  cities,  at  the  societies,  in  the  colleges  and  legislative  halls, 
which  has  a bearing  on  his  profession  ; as  well  as  with  such  personal 
intelligence  as  is  proper  to  be  published. 

The  price  is  $5.00  per  year,  payable  in  advance.  Specimen  copies 
will  be  sent  gratis  on  application. 


1 


THE  HALF-YEARLY 

Compendium  of  Medical  Science, 

ISSUED  JANUARY  1 AND  JULY  1, 

is  an  epitome  or  abstract  of  the  most  important  articles  which  liave 
appeared  in  European  and  American  Medical  Journals  during  the  six 
months  previous  to  its  publication.  It  is  the  only  publication  of  the 
kind  which  embraces  both  American  and  European  journals.  Each 
number  contains  300  large  8vo  pp.  with  Index. 

It  is  especially  adapted  to  be  taken  along  with  the  Bepokter, 
as  none  of  the  articles  in  the  one  publication  appear  in  the  other. 

The  price  of  the  Compendium:  is  $2.50  per  year.  The  Eeporter 
and  Compendium  together  are  $7.00  per  year. 

THE  PHYSICIAN’S  DAILY  POCKET  RECORD. 

All  who  have  made  use  of  this  Visiting  List  prefer  it  to  any  of  the 
others  in  the  market.  It  has  a ‘‘Perpetual  Calendar,”  which  allows  it 
to  be  commenced  any  time  in  the  year,  and  it  continues  good  for  one 
year  from  that  time.  It  contains  a complete  posological  table  in  the 
metric  and  ordinary  systems,  and  a large  amount  of  very  practical 
memoranda,  closely  condensed  and  very  perspicuously  arranged. 

It  is'  bound  with  a spring  clasp^  in  durable  moroc(!0,  and  is  adapted 
either  to  thirty-five  or  seventy  patients  per  week.  Price  for  thirty-five 
patients,  $1.50,  seventy  patients,  $2.00. 

1^  The  Eeporter  and  Compendium  for  one  year  and  a copy  of 
the  Pocket  Eecord,  with  the  name  of  the  purchaser  neatly  stamped  in 
gilt  on  the  cover,  will  be  sent  to  one  address  on  receipt  of  eight  dollars 
($8.00). 

From  hundreds  of  unsolicited  letters  of  the  kind  we  choose  at 
random  the  following  testimonials  to  the  worth  of  the  Eeporter. 

“ The  Reporter  comes  regularlj’^  to  my  address,  for  which  many  thanks.  It  is  the  best  publication 
of  a medical  kind  I receive.”  L.  C.  BUTLER,  ai  d., 

Ex-President  of  the  Vermont  State  Medical  Society. 

“I  find  the  Reporter  superior  to  all  other  medical  journals  which  I have  taken.  It  always 
embodies  the  most  advanced,  piactical  and  important  medical  literature.” 

DR.  THOS.  M.  WOODROX,  Tennessee. 

“For  the  daily  needs  of  a busy  practitioner  your  journal  is,  without  doubt,  superior  to  any  other 
printed.”  DR.  C.  E.  RICHARDS,  Milwaukee. 

“I  can  find  nothing  so  practical  as  the  Reporter.  I think  it  the  best  of  journals  for  the  busy 
practitioner.”  DR.  A.  L.  WILLIAMS,  Ohio. 

“I  would  regret  the  absence  of  the  Reporter  more  than  any  one  of  the  ten  medical  journals  I 
receive.”  DR.  W.  II.  SOLIS,  Michigan. 


2 


THE  MODERN 


TI  ERAPEUTics  Series. 


EXCITED  TO  ISSO. 


I. — MODERN  MEDICAL  THERAPEUTICS.  A Compendium  ot 
Recent  Formulae  and  Specific  Therapeutical  directions  from  the  practi:  e 
of  eminent  contemporary  physicians,  American  and  foreign.  By  Geo. 
IL  ITapheys,  A.M.,  M.D.  1 vol.,  8vo.,  pp.  607.  Price,  cloth,  $4.00; 
sheep,  $5.00. 

II. -MODERN  SURGICAL  THERAPEUTICS,  A Compendium  of 
Current  Formulae,  Approved  Dressings  and  Specific  Methods  for  th(‘ 
treatment  of  Surgical  Diseases  and  Injuries.  By  Geo.  II.  FTapiieys, 
A.M.,  M.D.  1 vol,  8vo.,  pp.  608.  Price,  cloth,  $4.00;  sheep,  $5.00." 

III. — THERAPEUTICS  OF  GYNiECOLOGY  AND  OBSTETRICS. 

Edited  by  Wm.  B.  Atkiysok,  m.d.,  etc.  1 vol.,  8vo.,  pp.  366.  Price, 
cloth,  $3.00;  sheep,  $3.50. 


This  Series  of  Therapeutics  has  been  recognized  by  the  Medical  Press, 
both  of  England  and  the  United  States,  to  be  the  most  practically  valu- 
able to  the  physician  of  any  which  is  now  in  the  market.  The  following 
hints  as  to  its  plan  will  give  some  idea  of  its  exceeding  usefulness: — 

IN  THE  MEDICAL  THERAPEUTICS  the  total  number  of  authors 
quoted  is  723,  and  the  precise  formulae  given,  1124.  Each  disease  is  taken 
up  and  its  treatment  presented  according  to  the  latest  and  best  authorities 
in  Europe  and  this  country.  Many  of  the  directions  and  formulae  have 
never  been  published  elsewhere.  A ‘‘Resume  of  Remedies”  follows 
each  disease,  showing  all  the  drugs  which  have  a well-merited  reputation 
in  the  therapeutics  of  the  complaint.  Nor  are  the  descriptions  confined 
to  drugs  only,  but  every  therapeutic  resource  in  a disease  is  specified, 
including  electricity,  bathing,  mineral  waters,  external  applications, 
climate,  diet,  sanitation,  etc.,  etc. 

IN  THE  SURGICAL  THERAPEUTICS  the  number  of  authors 
quoted  is  418 ; the  number  of  their  prescriptions  given,  1008.  The  spe- 
cial object  of  this  work  is  to  set  forth  the  medical  aspect  of  Surgery^  to 
collect  in  one  volume  the  Therapeutics  of  Surgery,  the  formulae  and 
medical  treatment  cf  Surgical  diseases  of  the  most  eminent  surgeons. 

3 


THE  THERAPrUTICS  OF  GYMCOLOGY  AND  OBSTETRICS 

presents  a condensed,  carefully  weighed  and  accurately  presented  review 
and  estimate  of  the  therapeutical  resources  of  the  gynoecologist  and 
obstetrician.  The  remarkable  activity  which  has  characterized  this 
specialty  of  late  years  has  vastly  increased  its  materia  medica  and  forms 
of  therapeutics  ; and  a summary  of  these  discoveries  and  improvements 
cannot  fail  to  be  welcome.  The  most  recent  publications  of  the  European 
press  and  all  the  special  journals  of  .both  continents  have  been  laid 
under  contribution. 


opmioisrs  op  the  press  ahd  op  readers. 

“This  is  a useful  and  interesting  book,  which  no  one  can  take  up  without  finding  something  he 
did  not  know  before.” — British  3Iedical  Journal^  August,  1880. 

“After  a close  scrutiny  we  have  come  to  the  conclusion  that  the  thorough  revision  given  to  the 
seventh  edition  of  this  book  (the  Medical  Therapeutics)  has  made  it  the  most  valuable  work  on 
treatment  a practitioner  can  possibly  procure.  It  is  abreast  of  the  latest  views.” — Medical  Press 
and  Circular  (London),  September,  1880. 

“This  work  is  well  conceived  and  carefully  executed,  and  will  be  of  very  great  service  to  the 
practitioner.”  The  Lancet,  London,  August,  1879. 

“Naphevs’  Therapeutics  is  a work  with  which  the  profession  has  become  well  acquainted 
through  its  former  editions.  The  present  edition  is  much  changed  from  the  last.  Many  additions 
have  been  made,  gathered  from  recent  sources,  and,  in  fact,  the  work  has  been  thoroughly  revised. 
As  a means  of  familiarizing  with  the  methods  and  remedies  employed  in  different  parts  of  the  world 
by  leading  practitioners,  no  other  book  is  equal  to  it.” — Pacific  Medical  Journal,  January,  1880. 

“Divested  as  they  are  of  all  that  is  not  strictly  practical,  containing  such  information  as  is -of 
every  day  requirement,  and  containing  no  useless  verbiage,  these  books  are  such  as  the  general 
practitioner  pariicularly  will  find  of  great  assistance.” — Michigan  Medical  News,  March,  1880. 

“Give  a practitioner  these  three  volumes,  and  one  or  two  good  journals,  and  he  needs  little  else, 
practically,  in  the  way  of  books.”  DK.  THOS.  M.  MATTHEWS,  Texas. 

“An  admirable  compendium  * * * an  eminently  practical  Avork.” — Michigan  Bledical  News. 

“A  unique  book;  it  shows  vast  labor  on  the  part  of  the  author.” — St.  Louis  Clinical  Record. 

“A  very  valuable  aid  to  practice,  indeed,  almost  indispensable.” — St.  Louis  Medical  and  Surgi- 
cal Journal. 

“Cannot  fail  to  help  almost  any  practitioner.” — Louisville  American  Practitioner. 

“ It  is  eminently  a jwactical  work.” — Louisville  Medical  News. 

“ In  no  other  work  can  the  practitioner  iearn  so  easily  the  favo'ite  medicines  in  t'  eating  disease, 
and  the  best  methods  in  compounding  them.” — Louisville  American  Medical  Biweekly. 

“ Of  the  utmost  practical  utility  to  every  physician  and  surgeon.  They  are  all,  and  more,  than 
the  editor  claims  for  them.” — Richmond,  Virginia,  Medical  Monthly. 

The  following  opinions  refer  to  the  Theraphutics  of  G-yk^ecology 
AXD  Obstetrics  : — 

“ This  book  is  one  which  the  general  practitioner  will  find  of  great  assistance  to  him.” — Michigan 
Medical  News,  March,  1880. 

“ It  is  concise  and  intensely  practical,  and  we  cordially  commend  it,  both  to  the  profession  and 
the  student.” — The  Therapeutic  Gazette,  March,  1880. 

“We  consider  it  superior  to  cither  one  of  the  other  Aolumcs.” — Cincinnati  Medical  News, 
March,  1880. 

“ We  recommend  it  as  filling  a general  Avant.” — Atlanta  Medical  and  Surgical  Journal, 
February,  1880. 


4 


A BIOGRAPHICAL  DICTIONARY 

OF 

CONTEMPORARY  AMERICAN  PHYSICIANS 

AND 

S TJ  C3- E 0 S . 


Edited  by-  WM.  B.  A.TKINSON,  M.  B., 

Permanent  Secretary  of  the  American  Medical  Association,  and  of  the  Pennsylvania  State  Medi- 
cal Society : Lecturer  on  Diseases  of  Children  at  the  yefferson  Medical  College,  etc. 

One  Volume,  Royal  Ociavo,  Double  Columns,  780  pp.,  on  Fine,  Tinted  Paper. 

J8@“REDUCED  PRICE.=^ 

With  52  Full-page  Steel  Portraits,  Half  Leather,  . $7.50 

Same  without  the  portraits, only  4.00 

This  really  monumental  work,  the  fruit  of  enormous  labor  and 
outlay,  contains  the  biographical  sketches  of  more  than  twenty- eight 
hundred  contemporary  regular  physicians  of  the  United  States,  prepared 
from  materials  in  most  instances  furnished  by  themselves,  and  hence 
entirely  trustworthy.  Indexes  of  names  and  places  are  appended-  The 
effort  has  been  made  to  embrace  all  who  have  visibly  contributed  to  the 
advancement  of  medical  science  in  all  parts  of  the  Union,  and  the  volume 
presents  a mass  of  most  valuable  historical,  biographical  and  scientific 
material. 


THE  PRINCIPLES  AND  METHODS 

OF 

THERAPEUTICS. 

BY  ALPHONSE  GUBLER,  M.D., 

Professor  of  Therapeutics  in  the  Faculty  of  Medicine  of  Paris,  etc. 

TRANSLATED  BY  M.  J.  HALLORAN,  M.D.,  Etc. 

Bound  in  Half  Morocco 9 muslin  sides ^ Brice  $4:, 00. 

Gubler  may  be  said  to  have  been  the  most  distinguished  exponent 
of  scientific  therapeutics — in  the  best  sense  of  the  term — of  this  genera- 
tion, Following  Trousseau  in  the  professorial  chair,  and  a pupil  of  that 
great  teacher,  he  took  a long  step  in  advance  of  his  master. 

5 


DIFFERENTIAL  DIAGNOSIS: 

A MANUAL  OF  THE  COMPARATIVE  SEMEIOLOGY  OF  THE 
MORE  IMPORTANT  DISEASES. 

By  DE  HAVILLAND  HALL,  M.D., 
Assistant  Physician  to  the  AVestminster  Hospital,  London. 
Second  American  Edition,  with  Extensive  Additions. 

EDITED  BY  FRANK  WOODBURY,  M.D. 

One  Volume,  8vo,  pp.  223.  Printed  on  handsome  tinted  paper;  bound  in  Lnglisli  pebbled 
cloth,  with  beveied  boards.  Price  $2.00. 

Dr.  Hall’s  work  has  received  the  highest  encomiums  from  the 
English  medical  press,  for  its  lucid  arrangement,  completeness  and  accu- 
racy. He  himself  is  known  in  London  as  a practitioner  of  great  skill, 
and  an  unusually  successful  medical  teacher. 

Most  of  the  diseases  which  may  he  confounded  are  presented  in 
comparative  tables,  setting  forth  their  distinctive  characteristics  in  the 
clearest  possible  light,  and  thus  greatly  facilitating  their  prompt  diag- 
nosis. 


THE  DISEASES  OF  LIVE  STOCK, 

INCLUDIXG  HOKSES,  CATTLE,  SHEEP  AND  SWINE. 

Containing  a descri'ption  of  all  the  usual  diseases  to  which  these  animals  are 
liable,  and  the  most  successful  treatment  of  American, 

English  and  European  Veterinarians. 

X.IhOYI>  V.  TELLOR,  M.R. 

1 vol.  8vo.  pp.  474.  Price,  Cloth,  $2.50. 

This  work  is  divided  into  four  parts,  as  follows : I.  General  Princi- 
ples of  Yeterinary  Medicine.  II.  Diseases  of  the  Horse.  III.  Diseases 
of  Cattle,  Sheep  and  Swine  lY.  Hygiene  and  Medicines. 

The  author  of  this  work  is  a regular  physician,  whose  practice  in  the 
country  has  led  him  to  study  the  diseases  of  domestic  animals,  and  we 
can  point  to  it  as  the  first  and  only  book,  by  an  American  physician, 
which  describes,  with  scientific  accuracy,  and  yet  in  plain  language, 
these  common  and  important  maladies. 

From  WILLIAM  A.  HAMMOND,  m.d.,  of  New  York  City,  Late  Surgeon  General,  U.  S. 
Army. 

“ I have  gone  through  Dr.  Teller’s  book  very  carefully,  and  regard  it  as  admirably  adapted  for 
the  use  of  those  who  arc  obliged  to  treat  their  own  animals.  It  is  eminently  practical  and  full  cf 
common  sense.” 

0 


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